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Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial
Gökhan Polat1, Halil İbrahim Balcı2, Mehmet Fevzi Çakmak2
1Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey. gokhanpolat7@gmail.com.
Insights
High tibial osteotomy (HTO) shows acceptable long-term outcomes for knee osteoarthritis. While closing-wedge osteotomy impacts alignment, functional results and survival rates are comparable across techniques.
Area of Science:
- Orthopedics
- Biomechanics
- Knee Surgery
Background:
- Medial compartment arthrosis is a common cause of knee pain.
- High tibial osteotomy (HTO) is a surgical procedure to treat knee osteoarthritis.
- Comparing different HTO techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To analyze the long-term outcomes of high tibial osteotomy (HTO) using three distinct surgical techniques.
- To compare the effectiveness and survival rates of different HTO methods for medial compartment arthrosis.
Main Methods:
- Retrospective evaluation of 187 patients (195 knees) who underwent HTO between 1990 and 2010.
- Three techniques were compared: opening-wedge with Puddu plate, transverse osteotomy with external fixator, and closing-wedge with staple fixation.
- Long-term functional outcomes assessed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) scores; survival rates analyzed via Kaplan-Meier analysis.
Main Results:
- Closing-wedge osteotomy demonstrated significant lateralization of mechanical axis deviation (MAD), increased medial proximal tibial angles (MPTA), and reduced posterior tibial slope (PTS).
- No significant functional differences were observed between the three HTO groups based on KSS and HSS scores at long-term follow-up.
- Kaplan-Meier survival analysis indicated a 10-year survival probability of 71.2% for the native knee joint post-HTO, with 16% requiring revision to total knee replacement.
Conclusions:
- High tibial osteotomy (HTO) offers acceptable long-term clinical and functional results for medial compartment arthrosis.
- Orthopedic surgeons should consider HTO as a viable option, not to be underestimated when faced with pressure to perform arthroplasty.
- The choice of HTO technique may influence biomechanical parameters, but long-term functional outcomes appear comparable.
Background:
The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis.
Methods:
A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments.
Results:
In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan-Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients.
Conclusions:
HTO has acceptable long-term clinical and functional results that should not be underestimated by orthopedic surgeons under pressure to perform arthroplasty operations.
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