OJO  Vol.9 No.1 , January 2019
Biplanar Open-Wedge High Tibial Osteotomy with Locking Plate for Treatment of Osteoarthritic Varus Knee
ABSTRACT
Aim: To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat unicompartmental knee arthritis with varus deformity in active life patients. Patients and Method: 48 patients (19 females) with monocompartmental gonarthrosis of the knee combined with varus malalignment, 41 with bilateral affection and 7 cases with unilateral gonarthritis (total 89 knees). Mean age: 53 years (range from 42 to 61 years). They were treated and followed from June 2010 to May 2014 (35 months). Biplanar opening high tibial osteotomy technique was used and fixed by low profile locked T-plate (21 cases) and low profile anatomical proximal tibial plate (27cases). Pre-operative mean varus deformity was 16.5° (9° - 19°). We utilized Lysholm score and Knee Society Score for evaluation of preoperative and follow-up data. Results: The average correction angle was 11.50 ± 2.50° (7° - 19°). Preoperative posterior tibial slope was 8.04° ± 1.30° and at last follow-up 9.15° ± 1.60°, respectively (p = 0.437). The joint space distance increased from 4.05 ± 1.30 mm to 4.83 ± 1.33 mm (p < 0.001). The average time to complete bone union was 14.69 ± 1.5 weeks. There were no cases of delayed union or non-union. No major complications like broken plate, nerve injury, or blood vessel injury occurred. No progression of degenerations developed in the three compartments of the knee at final follow-up. The mean score on the Lysholm-Gillquist knee functional scoring scale was 45.5 ± 21.7 preoperatively, and it improved to 77.0 ± 23.9 (p < 0.001). There was no obvious difference in the range of motion before and after operation. The average knee score improved from 51.19 ± 11.82 to 93.49 ± 5.10. Conclusion: Biplanar opening high tibial osteotomy fixed with locking compression plate gives good results for symptomatic unicompartmental gonarthrosis with genu varum. Also this technique can be applied for medial compartment degeneration of the knee without deformity with good functional outcomes.
Cite this paper
Kornah, B. , Abdel-Hameed, S. and Abdel-AAl, M. (2019) Biplanar Open-Wedge High Tibial Osteotomy with Locking Plate for Treatment of Osteoarthritic Varus Knee. Open Journal of Orthopedics, 9, 1-13. doi: 10.4236/ojo.2019.91001.
References
[1]   Aglietti, P., Rinonapoli, E., Stringa, G. and Taviani, A. (1983) Tibial Osteotomy for the Varus Osteoarthritis. Clinical Orthopedic and Related Research, 176, 239-251.

[2]   Langenbeck, B. (1854) Die subkutane osteotomie. Dtsch Klinik, 6, 327. (In German)

[3]   Coventry, M.B. (1965) Osteotomy of the Upper Portion of the Tibia for Degenerative Arthritis of the Knee. The Journal of Bone and Joint Surgery. American, 47, 984–990.
https://doi.org/10.2106/00004623-196547050-00008

[4]   Fowler, P.J., Tan, J.L. and Brown, G.A. (2000) Medial Opening Wedge High Tibial Osteotomy: How I Do It? Operative Techniques in Sports Medicine, 8, 32-38.
https://doi.org/10.1016/S1060-1872(00)80022-2

[5]   Kim, S.J., Mahajan, R.H., Park, K.Y., Kim, T.E. and Choi, W.J. (2007) Biplanar Medial Open-Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis of the Knee: A Novel Technique and Follow-Up. Operative Techniques in Orthopaedics, 17, 29-37.
https://doi.org/10.1053/j.oto.2006.10.001

[6]   Ahlback, S. (1968) Osteoarthrosis of the Knee. A Radiographic Investigation. Acta Radiologica: Diagnosis (Stockholm), Suppl 277, 7-72.

[7]   Dugdale, T.W., Noyes, F.R. and Styer, D. (1992) Preoperative Planning for High Tibial Osteotomy: The Effect of Lateral Tibiofemoral Separation and Tibiofemoral Length. Clinical Orthopaedics and Related Research, 274, 248-264.
https://doi.org/10.1097/00003086-199201000-00025

[8]   Lysholm, J. and Gillquist, J. (1982) Evaluation of Knee Ligament Surgery Results with Special Emphasis on Use of a Scoring Scale. The American Journal of Sports Medicine, 10, 150-154.
https://doi.org/10.1177/036354658201000306

[9]   Fujisawa, Y., Masuhara, K. and Shiomi, S. (1979) The Effect of High Tibial Osteotomy on Osteoarthritis of the Knee. An Arthroscopic Study of 54 Knee Joints. Orthopedic Clinics of North America, 10, 585-608.

[10]   Kyung, H.S., Lee, B.J., Kim, J.W. and Yoon, S.D. (2015) Biplanar Open Wedge High Tibial Osteotomy in the Medial Compartment Osteoarthritis of the Knee Joint: Comparison between the Aescula and TomoFix Plate. Clinics in Orthopedic Surgery, 7, 185-190.

[11]   Herningou, P., Medevill, D., Debeyre, J. and Goutallier, D. (1987) Proximal Tibial Osteotomy with Varus Deformity: A Ten to Thirteen Year Follow-Up Study. The Journal of Bone and Joint Surgery. American, 69, 332-354.
https://doi.org/10.2106/00004623-198769030-00005

[12]   Brouwer, R.W., Bierma-Zeinstra, S.M., van Raaij, T.M. and Verhaar, J.A. (2006) Osteotomy for Medial Compartment Arthritis of the Knee Using a Closing Wedge or an Opening Wedge Controlled by a Puddu Plate. A 1-Year Randomised, Controlled Study. The Journal of Bone and Joint Surgery. British, 88, 1454-1459.
https://doi.org/10.1302/0301-620X.88B11.17743

[13]   Nakamura, E., Mizuta, H., Kudo, S., Takagi, K. and Sakamoto, K. (2001) Open-Wedge Osteotomy of the Proximal Tibial Hemicallotasis. The Journal of Bone and Joint Surgery. British, 83, 1111-1115.
https://doi.org/10.1302/0301-620X.83B8.11993

[14]   Marti, C.B., Gautier, E., Wachtl, S.W. and Jakob, R.P. (2004) Accuracy of Frontal and Sagittal Plane Correction in Open-Wedge High Tibial Osteotomy. Arthroscopy, 20, 366-372.
https://doi.org/10.1016/j.arthro.2004.01.024

[15]   El-Azab, H., Halawa, A., Anetzberger, H. and Hinterwimmer, S. (2008) The Effect of Closed- and Open-Wedge High Tibial Osteotomy on Tibial Slope: A Retrospective radiological Review of 120 Cased. The Journal of Bone and Joint Surgery. British, 90, 1193-1197.
https://doi.org/10.1302/0301-620X.90B9.20688

[16]   Abdel Megied, W.S., Mahran, M.A., Thakeb, M.F., Amr, A.K. and El-batrawy, Y. (2010) The New “Dual Osteotomy”: Combined Open Wedge and Tibial Tuberosity Anteriorisation Osteotomies. International Orthopaedics, 2, 231-237.

[17]   Schallberger, A., Jacobi, M., Wahl, P., Maestretti, G. and Jakob, R.P. (2011) High Tibial Valgus Osteotomy in Unicompartmental Medial Osteoarthritis of the Knee: A Retrospective Follow-Up Study over 13-21 Years. Knee Surgery, Sports Traumatology, Arthroscopy, 19, 122-127.
https://doi.org/10.1007/s00167-010-1256-4

[18]   Luites, J.W.H., van Heerwaarden, R., Valstar, E.R. and Wymenga, A.B. (2006) Stability of Open vs. Closed Wedge High Tibial Osteotomy Measured with Roentegen Stereophotogrammetric Analysis in a Randomised Clinical Trial. ESSKA Congress.

[19]   Pape, D., Lorbach, O., Schmitz, C., et al. (2010) Effect of a Biplanar Osteotomy on Primary Stability Following High Tibial Osteotomy: A Bio-mechanical Cadaver Study. Knee Surgery, Sports Traumatology, Arthroscopy, 18, 204-211.
https://doi.org/10.1007/s00167-009-0929-3

[20]   Onodera, J., Kondo, E., Omizu, N., et al. (2014) Beta-Tricalcium Phosphate Shows Superior Absorption Rate and Osteoconductivity Compared to Hydroxyapatite in Open-Wedge High Tibial Osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy, 22, 2763-2770.
https://doi.org/10.1007/s00167-013-2681-y

[21]   Staubli, A.E. and Jacob, H.A. (2010) Evolution of Open-Wedge High-Tibial Osteotomy: Experience with a Special Angular Stable Device for Internal Fixation without Interposition Material. International Orthopaedics, 34, 167-172.
https://doi.org/10.1007/s00264-009-0902-2

[22]   Hopwood, S., Khan, W. and Agarwal, S. (2016) The Biplanar Open Wedge High Tibial Osteotomy Preserving the Tibial Tubercle. Journal of Orthopaedic Science, 21, 786-790.

 
 
Top