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Results of high tibial osteotomy: review of the literature

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Abstract

The aim of this review is to evaluate long-term follow-up and survival analysis studies regarding high tibial osteotomies (HTO) for the treatment of medial knee arthritis. Despite the good number of studies available, comparison and pooling of the results are challenging because of the different evaluation systems and techniques used. However, in general, published studies on HTO report good long-term results with a correct patient selection and a precise surgical technique. Based on our findings, the ideal candidate for an HTO is a young patient (<60 years of age), with isolated medial osteoarthritis, with good range of motion and without ligamentous instability. Furthermore, the literature review shows that the outcomes gradually deteriorate with time. Nevertheless, some issues remain that need resolution; 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 unicompartmental knee arthroplasty and whether HTO significantly affects a subsequent total joint replacement.

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References

  1. Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251

    PubMed  Google Scholar 

  2. Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(3):291–300

    Article  CAS  PubMed  Google Scholar 

  3. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90(5):592–596

    Article  CAS  PubMed  Google Scholar 

  4. Amendola A, Bonasia DE. Osteotomy (HTO/DFO). In: Cole B, Gomoll A (eds) AAOS complications in orthopaedics: articular cartilage repair. (in press)

  5. Amendola A, Bonasia DE. Results of HTO in medial OA of the knee. In: Amendola A, Bellemans J, Bonnin M, MacDonald S, Menetrey J (eds) Surgery of the knee. (in press)

  6. Amendola A, Panarella L (2005) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Orthop Clin North Am 36(4):497–504

    Article  PubMed  Google Scholar 

  7. Amendola A, Rorabeck CH, Bourne RB, Apyan PM (1989) Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty 4(Suppl):S11–S17

    Article  PubMed  Google Scholar 

  8. Amendola A (2003) Unicompartmental osteoarthritis in the active patient: the role of high tibial osteotomy. Arthroscopy 19(10):109–116

    Article  PubMed  Google Scholar 

  9. Aryee S, Imhoff AB, Rose T, Tischer T (2008) Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 29(26):3497–3502

    Article  CAS  PubMed  Google Scholar 

  10. Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF (2006) High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 14:948–954

    Article  PubMed  Google Scholar 

  11. Broughton NS, Newman JH, Baily RA (1986) Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5–10 years' follow-up. J Bone Joint Surg Br 68(3):447–452

    CAS  PubMed  Google Scholar 

  12. Brouwer RW, Bierma-Zeinstra SMA, Raaij TM, Verhaar JAN (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu Plate. J Bone Joint Surg Br 88(11):1454–1459

    Article  CAS  PubMed  Google Scholar 

  13. Brouwer RW, van TM Raaij, Bierma-Zeinstra SM, Verhagen AP, Jakma TS, Verhaar JA (2007) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 18(3):CD004019

    Google Scholar 

  14. Buser D, Hoffmann B, Bernard JP, Lussi A, Mettler D, Schenk RK (1998) Evaluation of filling materials in membrane—protected bone defects. A comparative histomorphometric study in the mandible of miniature pigs. Clin Oral Implants Res 9(3):137–150

    Article  CAS  PubMed  Google Scholar 

  15. Chiang H, Hsu H, Jiang C (2006) Dome-shaped high tibial osteotomy: a long-term follow-up study. J Formos Med Assoc 105(3):214–219

    Article  PubMed  Google Scholar 

  16. Coventry MB (1973) Osteotomy about the knee for degenerative and rheumatoid arthritis: indications, operative techniques and results. J Bone Joint Surg Am 55:23–48

    CAS  PubMed  Google Scholar 

  17. Coventry MB, Bowman PW (1982) Long-term results of upper tibial osteotomy for degenerative arthritis of the knee. Acta Orthop Belg 48:139–156

    CAS  PubMed  Google Scholar 

  18. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75(2):196–201

    CAS  PubMed  Google Scholar 

  19. Dallari D, Savarino L, Stagni C, Cenni E, Cenacchi A, Fornasari PM, Albisinni U, Rimondi E, Baldini N, Giunti A (2007) Enhanced tibial osteotomy healing with use of bone grafts supplemented with platelet gel or platelet gel and bone marrow stromal cells. J Bone Joint Surg Am 89(11):2413–2420

    Article  CAS  PubMed  Google Scholar 

  20. Dettoni F, Maistrelli GL, Rossi P, Castoldi F, Stojimirovich D, Rossi R (2008) UKA versus HTO: clinical results at short term follow up. 75th AAOS Annual Meeting. San Francisco, CA

  21. Eid K, Zelicof S, Perona BP, Sledge CB, Glowacki J (2001) Tissue reactions to particles of bone-substitute materials in intraosseous and heterotopic sites in rats: discrimination of osteoinduction, osteocompatibility, and inflammation. J Orthop Res 19(5):962–969

    Article  CAS  PubMed  Google Scholar 

  22. Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96

    Article  PubMed  Google Scholar 

  23. Gaasbeek RD, Toonen HG, van Heerwaarden RJ, Buma P (2005) Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients. Biomaterials 26(33):6713–6719

    Article  CAS  PubMed  Google Scholar 

  24. Gstöttner M, Pedross F, Liebensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128(1):111–115

    PubMed  Google Scholar 

  25. Insall J, Shoji H, Mayer V (1974) High tibial osteotomy. A five-year evaluation. J Bone Joint Surg Am 56:1397–1405

    CAS  PubMed  Google Scholar 

  26. Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72:238–244

    CAS  PubMed  Google Scholar 

  27. Karabatsos B, Mahomed NN, Maistrelli GL (2002) Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg 45(2):116–119

    PubMed  Google Scholar 

  28. Kawaguchi H, Jingushi S, Izumi T, Fukunaga M, Matsushita T, Nakamura T, Mizuno K, Nakamura T, Nakamura K (2007) Local application of recombinant human fibroblast growth factor-2 on bone repair: a dose-escalation prospective trial on patients with osteotomy. J Orthop Res 25(4):480–487

    Article  CAS  PubMed  Google Scholar 

  29. Kazakos KJ, Chatzipapas C, Verettas D, Galanis V, Xarchas KC, Psillakis I (2008) Mid-term results of total knee arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg 128:167–173

    Article  PubMed  Google Scholar 

  30. Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444

    Article  PubMed  Google Scholar 

  31. LeGeros RZ (2002) Properties of osteoconductive biomaterials: calcium phosphates. Clin Orthop Relat Res 395:81–98

    Article  PubMed  Google Scholar 

  32. Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res 229:193–200

    PubMed  Google Scholar 

  33. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to 22-year followup study. Clin Orthop Relat Res 367:18–27

    Article  PubMed  Google Scholar 

  34. Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:403–408

    Article  CAS  PubMed  Google Scholar 

  35. Rudan JF, Simurda MA (1990) High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 255:251–256

    PubMed  Google Scholar 

  36. Segal NA, Buckwalter JA, Amendola A (2006) Other surgical techniques for osteoarthritis. Best Pract Res Clin Rheumatol 20(1):155–176

    Article  PubMed  Google Scholar 

  37. Shaw JA, Moulton MJ (1996) High tibial osteotomy: an operation based on a spurious mechanical concept. A theoretic treatise. Am J Orthop 25:429–436

    Article  CAS  PubMed  Google Scholar 

  38. Spahn G, Mückley T, Kahl E, Hofmann GO (2006) Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon) 21(3):272–278

    Article  Google Scholar 

  39. Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85-A:469–474

    PubMed  Google Scholar 

  40. Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon) 19(9):944–950

    Article  Google Scholar 

  41. Stoll T (2004) New aspects in osteoinduction. Materialwiss Werkstofftech 35(4):198–202

    Article  CAS  Google Scholar 

  42. Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. Knee 8(3):187–194

    Article  CAS  PubMed  Google Scholar 

  43. Tang WC, Henderson IJP (2005) High tibial osteotomy: long term survival analysis and patients’ perspective. Knee 12:410–413

    Article  PubMed  Google Scholar 

  44. van Raaij TM, Bakker W, Reijman M, Verhaar JAN (2007) The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 8:74–79

    Article  PubMed  Google Scholar 

  45. Zhim F, Laflamme GY, Viens H, Saidane K, Yahia L (2005) Biomechanical stability of high tibial opening wedge osteotomy: internal fixation versus external fixation. Clin Biomech (Bristol, Avon) 20(8):871–876

    Article  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA

    Annunziato Amendola

  2. University of Iowa Sports Medicine, Via Lamarmora 26, Turin, 10128, Italy

    Davide Edoardo Bonasia

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  1. Annunziato Amendola
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  2. Davide Edoardo Bonasia
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Correspondence to Davide Edoardo Bonasia.

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Amendola, A., Bonasia, D.E. Results of high tibial osteotomy: review of the literature. International Orthopaedics (SICOT) 34, 155–160 (2010). https://doi.org/10.1007/s00264-009-0889-8

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