Abstract
Introduction
Medial opening wedge high tibial osteotomy (HTO) is surgical treatment option for the management of medial compartment knee osteoarthritis.1 High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthrosis. Many techniques have been developed (i.e. closing wedge, opening wedge, dome and “en chevron” osteotomies), but opening (medial) and closing (lateral) wedge osteotomies are the most commonly used. The goal of the treatment is to relieve medial compartment knee pain and slow down the arthritic progression. The surgery is described as a biomechanical intervention designed to alter dynamic knee joint loading, with the aim of improving patient function and decreasing pain This is achieved by a partial unloading of the medial compartment with a slight overcorrection 3-5 degree of the mechanical axis. Some studies showed that regenerative process began after realignment. HTO was considered as an option to treat an isolated medial compartment Osteoarthritis (OA) in Varus knees, which was reported by Jackson in 1958. This surgery was not popular until Coventry reported good results in 19732, HTO became more popular in young active patients after improvement in surgical technique, fixation devices, and patient selection with fewer complications. Although overall HTO results show the effectiveness of the procedure there are still some debated issues about osteotomies. These include the choice between opening or closing wedge tibial osteotomy, the graft selection in opening wedge osteotomies, the type of fixation, the comparison with uni-compartmental knee arthroplasty (UKA) and whether HTO affects a subsequent total joint replacemen(TKR)
References
- Khan A, Ifthekar S. Evaluation of functional outcome of high tibial osteotomy in medial compartment osteoarthritis of knee fixed with orthofix and puddu plate: A comparative study. ~ 408 ~ Int J Orthop Sci [Internet]. 2018;4(3):408–13.
- Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G. The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg. 2005;125(9):638–43.
- Flandry F, Hommel G. Normal Anatomy and Biomechanics of the Knee. 2011;19(2):82–92.
- Leitch KM. Biomechanical Investigations of Medial Opening Wedge High Tibial Osteotomy: Gait Analysis, Matrials Testing and Dynamic Radiography. 2014;(April).
- Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res [Internet]. 2016 Aug;474 (8):1886–93.
- Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006;
- McAlindon T, Dieppe P. Osteoarthritis: Definitions and criteria. Ann Rheum Dis. 1989;
- Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am [Internet]. 1979 Jul;10(3):585–608.
- Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H. Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res [Internet]. 1988 Apr;(229):193–200.
- Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res [Internet]. 1990 Jun;(255):251–6.
- Ivarsson I, Myrnerts R, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br [Internet]. 1990 Mar;72(2):238–44.
- Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res [Internet]. 1999 Oct;(367):18–27.
- Michaela G, Florian P, Michael L, Christian B, Liebensteiner M, Michael L, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg [Internet]. 2007 Oct 30;128(1):111–5.
- Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: A TEN- TO 20-YEAR FOLLOW-UP. J Bone Jt Surg - Br Vol [Internet]. 2008;90–B(5):592–6.
- McNamara I, Birmingham TB, Fowler PJ, Giffin JR. High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2013 Jan 28;21(1):23–31.
- Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW. A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2013 Jan 19;21(1):90–5.
- Hernigou P. Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee [Internet]. 2002 Feb;9(1):15–20.
- Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2003 May 11;11(3):132–8.
- Samani SS, Kachooei AR, Ebrahimzadeh MH, Omidi Kashani F, Mahdavian Naghashzargar R, Razi S. Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies. Iran Red Crescent Med J [Internet]. 2013 May 5;15(4):335–9.
- Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. Injury [Internet]. 2003 Nov;34 Suppl 2:B55-62
Corresponding Author
Dr Manish J. Choudhary
Junior Resident, Department of Orthopaedics, KMCH, Katihar
DOI: https://dx.doi.org/10.18535/jmscr/v10i12.11
