Combined Lateral Closing and Medial Opening-Wedge High Tibial Osteotomy

Abstract

Long-term studies have indicated that the clinical success of high tibial osteotomy deteriorates with time. The purpose of this study was to evaluate the long-term results of a combined lateral closing and medial opening-wedge technique for high tibial osteotomy with a minimum follow-up of fifteen years. From January 1981 to June 1990, ninety-two patients (ninety-four knees) had a high tibial valgus osteotomy. The average preoperative varus deformity was 13.5 degrees . The surgical technique consisted of a proximal lateral closing-wedge osteotomy and use of the lateral wedge as a graft on the medial side of the osteotomy. No internal fixation was used. A knee brace was used to maintain the 8 degrees to 10 degrees of valgus overcorrection. Seventy-two knees in seventy patients with at least fifteen years of follow-up were evaluated. Clinical evaluation was done with The Hospital for Special Surgery knee-rating scale. The femorotibial alignment, posterior tibial slope, and the Insall-Salvati ratio were measured on radiographs. The mean initial postoperative correction (and standard deviation) for all knees was to 8.3 degrees +/- 2.7 degrees of valgus alignment. Survivorship analysis showed that the probability of survival (and 95% confidence interval), with conversion to total knee arthroplasty as the end point, was 100% at one year, 92% +/- 5.8% at ten years, 80% +/-7.7% at fifteen years, and 58% +/- 4.3% at twenty years. The survivorship, with a Hospital for Special Surgery knee score of <70 points as the end point, was 80% +/- 4.5% at ten years, 72% +/- 5.6% at fifteen years, and 42% +/- 4.2% at twenty years. Twenty-six knees underwent an arthroplasty at an average of 15.6 years after the index procedure. For the forty-six knees that had not undergone an arthroplasty, the knee score improved from an average of 67 points preoperatively to 82 points at the time of the most recent follow-up. There were two superficial wound infections and one delayed union. We believe that our technique of a combined lateral closing and medial opening-wedge high tibial osteotomy can provide good long-term outcomes because of the off-loading of the diseased medial compartment with minimal complications.