[Valgus high tibial osteotomy - long-term results]

Area of Science:

• Orthopedic surgery
• Biomechanical engineering
• Rehabilitative medicine

Background:

• High tibial osteotomy (HTO) is a surgical procedure to correct knee malalignment.
• Proximal tibial valgus osteotomy aims to realign the knee joint, particularly in cases of osteoarthritis.
• Long-term outcomes of HTO are crucial for patient quality of life and surgical decision-making.

Purpose of the Study:

• To evaluate the long-term efficacy and outcomes of proximal tibial valgus osteotomy.
• To assess the impact of surgical technique, correction, and patient factors on HTO results.
• To compare HTO outcomes with alternative treatments like total knee arthroplasty (TKA).

Main Methods:

• Retrospective evaluation of 92 high tibial osteotomies for primary osteoarthritis.
• Closing wedge osteotomy technique with varying fixation (staples, plates, cerclage) and immobilization durations.
• Kaplan-Meier survival analysis to determine the favorable effect duration, with pain and walking problems as endpoints.

Main Results:

• Good results were observed up to 10 years post-osteotomy, with 47.6% of patients reporting positive outcomes.
• Long-term success (15 years) was lower (14.3%), with 30.4% remaining symptom-free.
• Inadequate correction and complications significantly worsened outcomes (p=0.003), while longer immobilization led to poorer results (p=0.04).

Conclusions:

• Proximal tibial valgus osteotomy can be effective for up to 10 years in select osteoarthritis patients.
• Total knee arthroplasty generally offers better long-term results, but osteotomy can postpone the need for TKA.
• Corrective osteotomy remains a valuable complementary treatment for knee osteoarthritis, especially in younger patients with axial malalignment.