Abstract
BackgroundHybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO.MethodsThe study cohort consisted of 30 patients (15 men and 15 women) who underwent hybrid CWHTO for medial compartment osteoarthritis or spontaneous osteonecrosis of the knee. Sixteen knees were fixed with a lateral locking plate (LP group), and 17 were fixed with both a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia (LPS group). The times to bone union, radiolucency, and callus formation at the osteotomy site were evaluated radiographically.ResultsThe mean postoperative time to radiographic confirmation of bone union was 5.5 ± 2.6 months in the LP group and 3.4 ± 1.5 months in the LPS group. Radiolucency at the osteotomy site and excess callus formation on the posterior side of the tibia were lower in the LPS group than in the LP group.ConclusionsThis modified hybrid CWHTO combining a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia improves the stability of the osteotomy site and shortens the period of bone union.
Highlights
Hybrid closed-wedge high tibial osteotomy is an effective surgical treatment for medial compartment osteoarthritis of the knee
Bone union was achieved in an average of 4.5 months, 25% of advanced varus knees required more than 6 months for bone union, allowing full weight-bearing within 4 weeks after hybrid closed-wedge High tibial osteotomy (HTO) (CWHTO) [10]
Hybrid CWHTO was indicated in patients with a projected angle of less than 10 degrees when the severity of patellofemoral OA was greater than stage III radiographically or when patients with knee OA experienced anterior knee pain or crepitus [9]
Summary
Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO. Hybrid CWHTO has been reported to be more effective than medial open-wedge HTO in patients with OA of the patellofemoral joint and those with advanced varus knees [9]. In hybrid CWHTO, the tibial tuberosity is cut using the biplanar osteotomy method, and the patellar tendon insertion point is elevated anteriorly and repositioned proximally. Hybrid CWHTO is effective for knees with medial-compartment OA and patellofemoral joint OA [8]. Improving the fixation of the medial fragment in hybrid CWHTO may be necessary to promote early full weight-bearing and bone union
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