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Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and

Frank R Noyes1, William Mayfield, Sue D Barber-Westin

  • 1Cincinnati Sportsmedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242, USA.

The American Journal of Sports Medicine
|February 24, 2006
PubMed
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This study demonstrates that using an autologous iliac crest bone graft during high tibial osteotomy prevents complications like nonunion and arthrofibrosis. Early weightbearing and rehabilitation were safely achieved, improving patient outcomes.

Area of Science:

  • Orthopedic surgery
  • Bone healing and regeneration
  • Knee joint biomechanics

Background:

  • High tibial osteotomy (HTO) is frequently associated with complications such as delayed union, nonunion, arthrofibrosis, and patella infera.
  • These complications can impede patient recovery and long-term knee function.

Purpose of the Study:

  • To evaluate a technique for opening wedge high tibial osteotomy (HTO) that incorporates an autogenous iliac crest bone graft.
  • To determine if this technique prevents delayed union, nonunion, arthrofibrosis, and patella infera, while allowing early rehabilitation and weightbearing.
  • To assess if specific methods for calculating valgus alignment correction prevent alterations in tibial slope.

Main Methods:

  • A case series (Level of evidence, 4) of 55 consecutive patients undergoing HTO.

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  • Preoperative and postoperative radiographic measurements assessed bony union, tibial slope, and patellar height.
  • Osteotomy opening size varied, with 64% of openings <=10 mm and 36% >11 mm.

    • Main Results:

    • All osteotomies achieved bony union, with only three cases experiencing delayed union (resolved by 6-8 months).
    • No infections, loss of knee motion, nerve/arterial injuries, or alterations in tibial slope were reported.
    • One case of fixation loss required revision due to immediate full weightbearing; all other patients achieved full weightbearing by a mean of 8 weeks postoperatively.

    Conclusions:

    • The described HTO technique, utilizing an autologous iliac crest bone graft and a progressive rehabilitation program, effectively prevented nonunion, tibial slope changes, and knee arthrofibrosis.
    • This approach facilitates early rehabilitation and weightbearing without compromising knee alignment or joint health.