Valgus High Tibial Osteotomy Research Articles

Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy.

We analyzed the time-dependent results after Coventry osteotomy in 118 patients (129 cases) with uni-compartmental osteoarthrosis of the knee. The median follow-up was 11.6 years (range 0.7-17 years). Data were noted according to the time since surgery. Group I (> 2 years) consisted of all 129 cases, group II (> 4 years) of 41 cases and group III (> 8 years) of 15 cases. The HSS knee score (max. 100 points) improved from 33.2 +/- 20.4 (range 17-60) to 68.3 +/- 25.3 (range 30-90) in group I, to 54.7 +/- 18.9 (range 29-90) in group II and to 43.7 +/- 20.9 (range 23-85) in group III. The improvement started 4.6 +/- 7.8 months (range 0-60 months) after the operation and persisted for 4 years +/- 37.4 months (range 0-125 months). The functional knee score (max. 100 points) changed from 61.7 +/- 14.1 (range 41-70) to 71.7 +/- 13.1 (range 53-87) in group I, to 70.0 +/- 11.8 (range 54-88) in group II and to 64.2 +/- 8.0 (range 42-90) in group III. The initial loss in knee flexion was 5.6 degrees (range 0 degree-20 degrees) and for extension 1.0 degree (range -5 degrees-25 degrees). Anteroposterior ligament stability (max. 10 points) decreased from 9.2 +/- 2.1 (range 2-10) to 5.6 +/- 1.7 (range 2-9) in group III. Lateral ligament stability (max. 15 points) was relatively constant, from 12.6 +/- 1.9 (range 4-15) to 9.7 +/- 1.9 (range 2-14). Complications included one tibia fracture, one infection, six peroneus pareses, four haematomas and one pseudarthrosis. The mechanical axis was corrected to an average knee valgu2 of 5.2 degrees +/- 7.4 degrees, which deteriorated over time. Radiographic evidence of arthrosis appeared independent of the operation.

Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy

Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy

High tibial osteotomy with Giebel plate

High tibial valgus osteotomy remains an important surgical option for varus gonarthrosis of the knee. Recent trends have been towards more rigid internal fixation to permit early range of motion and minimize the morbidity of enforced knee immobilization. We report our experience with the Giebel blade plate for this procedure. A retrospective review was undertaken of all high tibial valgus closing wedge osteotomies for medial gonarthrosis performed by two of us (GCRK and RDO) using the Giebel® blade plate (Waldemar Link GMBH and Co., Hamburg, Germany) for fixation. Thirty-three patients were identified as having had the procedure and thirty-one returned for clinical review by an independent assessor (GFD). The surgical technique aimed to overcorrect the varus deformity to 10° anatomic tibio-femoral valgus. The fibular head was partially excised to permit correction. The Giebel plate is made of stainless steel and its design followed the modified semi tubular plate described by Weber [10] for osteotomy fixation. There were 25 male and 9 female knees and the mean age at operation was 46 years (range 26–62). The anatomic tibio-femoral alignment averaged 0.8° valgus pre-op and 9.8° valgus post-op. Six patients were overcorrected, defined as anatomic tibio-femoral valgus > 15° and 2 patients were undercorrected, being <5°. Sixteen patients completed a >2-year follow-up, (mean 29.4 months, range 24–44) and were reviewed for functional outcome according to the Knee Society rating system. The means and standard deviation were 75 ± 12.9 for the Knee score and 82.9 ± 15 for the Function score. No complications as a result of the fixation were apparent and only two patients required implant removal for soft tissue irritation. Two patients required further surgery: one patient was overcorrected to 18° valgus and salvaged with total knee arthroplasty while another required a second osteotomy because of undercorrection.

High tibial valgus osteotomy using lyophilised human grafts: results of 37 cases with at least a year's follow-up

High tibial valgus osteotomy using lyophilised human grafts: results of 37 cases with at least a year's follow-up

Meniscal allograft transplantation for unicompartmental arthritis of the knee.

Sixty-seven meniscal allografts were transplanted in the knees of 63 patients between 1988 and 1994. Before surgery, all patients experienced refractory disabling knee pain secondary to a prior total meniscectomy with advanced unicompartmental osteoarthritic changes as verified by arthroscopy. At a mean followup of 31 months (range, 1.0-5.5 years), 58 knees (86.6%) attained a good to excellent results-Twenty-one knees received isolated meniscal allografts, with 19 achieving good to excellent results (90.5%). Five knees received a medial or lateral meniscal allograft with an anterior cruciate ligament reconstruction, and 4 (80.0%) obtained good to excellent results. Thirty-four knees received a meniscal allograft in combination with either a valgus high tibial osteotomy, varus high tibial osteotomy, or varus distal femoral osteotomy to correct for preoperative varus or valgus deformities, with 29 (85.3%) attaining good to excellent results. The remaining 7 knees underwent a combined medial meniscal allograft, valgus high tibial osteotomy, and anterior cruciate ligament reconstruction with 6 (85.7%) attaining good to excellent results. The most frequent complication was a traumatic posterior horn tear in 6 knees at a mean of 21 months after surgery (range, 9-43 months), most likely the consequence of unsuccessful healing of the posterior horn of the graft.

Stabilization of high tibial osteotomy with staples.

Patients presenting with painful arthritis of the medial knee compartment with an intact lateral compartment are treated by high tibial valgus osteotomy at our institution. Between 1989 and 1993, 75 high tibial valgus osteotomies were done. Of these, 52 were idiopathic, 22 post-traumatic, and 1 subsequent to an intra-articular infection of the knee. The condition of the lateral compartment was routinely checked arthroscopically. All osteotomies were stabilized with osteotomy staples. This provided immediate stability, allowing partial weight-bearing (15 kg). Because of the simplicity and the low complication rate, we recommend this technique as a suitable treatment for arthritis of the medial condyle of the knee.

Biomechanical comparison between high tibial osteotomy (HTO) and combined HTO and fibular osteotomy

The ojectives of this study were to determine the changes in the lateral ligamentous stability of knee joint that occur after performing high tibial osteotomy with and without fibular osteotomy. Utilizing cadaveric specimens, lateral ligamentous stability was assessed by calculating the length of the lateral collateral ligament, and the lateral opening at different flexion angles when varus stress was applied to the tibia. The Polhemus 3- SPACE system was used to collect motion data describing the six-degrees-of-freedom three-dimensional tibiofemoral motions. It was found that the separation distance between the two attachment points of the lateral collateral ligament decreased by an average of 5 mm at all flexion angles after performing a 5-degree valgus high tibial osteotomy. Performing an additional 5-degrees of osteotomy caused this distance to further decrease. It was further found that performing a fibular osteotomy following a 5-degree valgus high tibial osteotomy produced no changes in the length of the lateral collateral ligament. It was also found that the lateral opening increased an average of 5 mm at all flexion angles after performing a 5-degree valgus high tibial osteotomy. Performing a 10-degree osteotomy caused a further increase in the lateral opening. It was further found that performing a fibular osteotomy following a 5-degree valgus high tibial osteotomy caused the lateral opening to return to its original value. That is to say, the fibular osteotomy negated the lateral opening caused by the tibial osteotomy and produced a pattern of lateral opening similar to the one found in the intact knee.

Change of adduction moment about the hip, knee and ankle joints after high tibial osteotomy in osteoarthrosis of the knee

The purpose of this study was to investigate the change of load about the knee joint and the ipsilateral hip and ankle joints in the coronal plane after high tibial valgus osteotomy in nine patients, mean age 64 years, mean weight 81 kg, with moderate medial osteoarthrosis of the knee, compared to ten age-matched normal controls. Moments about the joints were assessed with a computerized Kistler force platform and a videorecording system before surgery, and 6 and 12 months after surgery. Loads in the joints are related to the peak and midstance external adduction moments and the area under the moment curve. In patients before surgery there was a significantly increased adduction moment in both the hip and knee joints compared to the normal controls. After surgery the adduction moment was reduced to subnormal levels in the knee and normal levels in the hip joint. The moments about the ankle joint were unaffected both by the knee deformity and by the corrective surgery. This study demonstrates that a varus malalignment in the osteoarthrotic knee is accompanied by increased load about the ipsilateral hip. We do not know if this increased load about the hip has any pathological significance, but one might suspect a more rapid progression of degenerative changes in the hip joint cartilage as a consequence of the increased load. We have also found that the frontal plane moment about the hip can be reduced to a normal level when the knee is changed into slight valgus. The reduced load might be beneficial to a patient with osteoarthrosis of the ipsilateral hip and knee.

Valgus Osteotomy With Anterior Cruciate Ligament Laxity

Some patients with medial joint degeneration post-medial meniscectomy also have a significant anterior cruciate ligament (ACL) instability. Ten patients were treated by a combined high tibial valgus osteotomy with ACL reconstruction. All patients had relief of instability and decreased pain, although only one returned to full activity. The operation is recommended as a salvage procedure for an ACL deficient knee with instability and medial joint degeneration.

Long term evaluation of high tibial valgus osteotomy

We present a long term evaluation of 100 high valgus tibial osteotomies with a mean follow up of 11 years. Knees with slight or moderate osteoarthritis had the best results. Slight overcorrection was beneficial, but gross overcorrection was not. There were few complications and the overall long term results were good.

Experience With a New Technique for Managing Severely Overcorrected Valgus High Tibial Osteotomy at Total Knee Arthroplasty

Total knee arthroplasty (TKA) after valgus proximal tibial osteotomy poses no major difficulties in most cases. There is, however, a small subgroup of severely overcorrected patients in whom TKA is particularly difficult. These patients require special considerations. A complex ligament reconstruction has been developed to allow simultaneous implantation of a minimally constrained total knee prosthesis for patients with failed, severely overcorrected valgus high tibial osteotomies. The technique is described in five patients. The mean age of the group was 57 years and the average follow-up period was 34 months (range, 12-72 months). A 100-point knee-evaluation scale was used to rate the knees before and after TKA. The average pre- and postoperative scores were 50 and 94, respectively. None of the patients was noted to have any more than mild instability in any direction postoperatively. Despite this extensive reconstruction, the group functioned as well as most recipients of more standard primary TKAs and demonstrated it is possible to avoid highly constrained implants, custom prostheses, or major bone grafts.

約２６年間放置された膝蓋靭帯断裂を伴う変形性膝関節症の１治験例

The patient was a 48-years-old male who had lacerated his left patellar tendon by a splintered fenster glass at the age of 22 years, resulting in a patella alta.Pain and disability in the knee developed about 10 years after the injury, which increased gradually with a varus deformity to the point that his daily activities were sererely disturbed for the past 3 years.A high tibial valgus osteotomy with anterior advancement of the tibial tuberosity and shortening of the scar tissue in place of the patellar tendon were simultaneously performed with a good result.

High Tibial Osteotomy Compared With High Tibial and Maquet Procedures in Medial and Patellofemoral Compartment Osteoarthritis

The effect of adding the Maquet tibial tubercle elevating procedure to a valgus high tibial osteotomy (HTO) in combined medial and patellofemoral disease had not been established. This prospective study evaluates clinically and roentgenographically the use of this osteotomy combination versus HTO alone in dual-compartment arthritis. Forty-four patients (46 knees) with dual-compartment disease from 1979 to 1984 were evaluated. Twenty-two patients were treated with 23 HTOs by a senior surgeon, and 22 were treated with 23 combined procedures by another surgeon. The two groups were matched according to age, sex, and preoperative clinical and roentgenographic disability. The minimum follow-up period was two years. All had more than 5 degrees valgus alignment at the follow-up evaluation, with an average of 11.2 degrees in the HTO group and 10.2 degrees in the combined osteotomy group. A modified Hospital for Special Surgery assessment (maximum, 100 points) was used with an optimum pain score of 30 points. All were followed roentgenographically with grading of the three knee compartments. In both groups, the total and pain scores improved significantly postoperatively. There was no statistical difference between the two groups in terms of mean postoperative femorotibial shaft alignment or clinical and roentgenologic outcome. Although HTO was a good procedure for pain relief for dual-compartment disease, the addition of Maquet procedure did not improve the results.

Evaluation of Patients for High Tibial Osteotomy

Fifty-one osteoarthritic knees evaluated by arthroscopic, roentgenographic, and clinical examinations prior to high tibial valgus osteotomy were reevaluated roentgenographically and clinically after a minimum follow-up period of five years (average, 6.2 years; range, 5-8.3 years). The number of good and excellent results decreased over time but was unrelated to the preosteotomy condition of the lateral and patellofemoral compartments as documented by arthroscopy. Knees with 7 degrees to 13 degrees of valgus angulation at the follow-up evaluation had significantly better results than knees with less than 7 degrees of valgus, regardless of the arthroscopic findings. Preosteotomy arthroscopic findings had no predictive value in evaluating patients for this procedure.

High Tibial Valgus Osteotomy

Thirty-one consecutive high tibial valgus osteotomies for varus gonarthrosis performed by one surgeon using one technique were evaluated to determine correction of deformity, functional result, subjective impression, and subsequent surgery for the same problem. Twenty-five patients had satisfactory follow-up evaluations. Preoperative tibiofemoral angulation averaged 7 degrees varus. Postoperative tibiofemoral angulation averaged 5 degrees valgus. Ninety-two percent had excellent or good results, according to Coventry's criteria and the H.S.S. knee score. Eighty-eight percent claimed postoperative improvement, 8% were unchanged, and one patient was worse. Eighty-eight percent had had no further surgery. Excellent/good results deteriorated from 92% at two years to 88% at five years, to 91% at seven years, and to 80% at nine years. This is a smaller rate of deterioration than noted in other series. Analgesic and antiinflammatory drug use was significantly reduced after operation. No significant differences were noted in patients older than or younger than 60 years of age at the time of surgical correction. Factors contributing to success included careful patient selection; correction of the limb to the mechanical axis; and precise surgical technique. Osteotomy proved a successful alternative to total knee replacement for treatment of varus gonarthrosis in a carefully selected group of patients.

High Tibial Osteotomy: A Retrospective Analysis of 30 Cases

In this review of 28 patients who had 30 high tibial valgus osteotomies done, with an average followup of 51 months, 43% were judged as satisfactory and 57% were judged as poor, according to the criteria of Harris and Kostiuk.1 Surgical-technical error was the most common finding associated with the poor results. The next most common finding was inadequate correction.

High tibial osteotomy in the treatment of osteoarthritis of the knee. The role of preoperative arthroscopy.

Sixty osteoarthritic knees that were evaluated by arthroscopic, radiographic, and clinical (Insall knee-rating scale) examination prior to high tibial valgus osteotomy were re-evaluated radiographically and clinically after a minimum follow-up of two years. After two and three years, the clinical scores of the knees with bicompartmental and tricompartmental osteoarthritis (including exposed subchondral bone in the lateral compartment) were the same as the scores of the knees with unicompartmental disease. The scores of the knees with 5 to 13 degrees of valgus alignment at two years were significantly higher (p less than 0.01) than the scores of the knees with less than 5 degrees of valgus angulation, regardless of the arthroscopy scores. Based on the results after two to three years, the arthroscopic findings prior to osteotomy appeared to have little, if any, predictive value in evaluating patients for this procedure.