Abstract
BackgroundThe purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis.MethodsA total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments.ResultsIn the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan–Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients.ConclusionsHTO has acceptable long-term clinical and functional results that should not be underestimated by orthopedic surgeons under pressure to perform arthroplasty operations.
Highlights
The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis
The following patients were excluded from this study: 25 patients (27 knees) who we could not contact, 13 patients who could not complete a final assessment, 2 patients who had a lower extremity injury after surgery, 2 patients who had undergone hip arthroplasty, and 8 patients who did not want to participate in the study
The indication for HTO operation had been accepted as grade 2 or grade 3 medial compartment arthrosis that had been evaluated by using standing AP and lateral x-rays according to the Kellgren-Lawrence classification [15]
Summary
The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis. High tibial osteotomy (HTO) is the main biologic treatment option for most of these cases, especially in those with an intact lateral compartment [4,5,6]. There are many surgical options for medial compartment arthrosis, such as arthroscopic debridement, HTO, resurfacing procedures, unicompartmental arthroplasty, and total knee arthroplasty [7,8,9,10]. Biologic treatment methods should be chosen primarily in young and active patients, HTO procedures have been ignored by most surgeons due to the technological improvements and the early term success of the resurfacing and unicompartmental knee arthroplasty procedures [11, 12]. HTO is a good option in middle-aged or older patients who are not good candidates for arthroplasty procedures due to the social differentiation and habits of the patients or the reluctance of the patients to undergo arthroplasty [13, 14]
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