Medium- and long-term results of high tibial osteotomy for varus gonarthrosis in an agricultural population

High tibial valgus osteotomy for varus gonarthrosis was performed in 63 con secutive patients in a homogenous agricultural population using two differe nt surgical techniques. Patients were divided into two groups. A two-level Mittelmeier osteotomy was performed in group A patients, and a lateral clos ed wedge high tibial osteotomy using the AO/ASIF L-plate was performed in g roup B patients. Operations were performed by two different groups of surge ons. Patients were evaluated postoperatively for correction of knee axis, f unctional result, subjective impression, and complications. In group A patients, 80% of the operated knees were corrected to the mechan ical axis and in group B patients, 82% of the knees were corrected to 6 deg rees-10 degrees valgus of the anatomical axis. Ninety percent, 70%, and 54% of group A and 91%, 73%, and 57% of group B patients were rated as satisfa ctory results at 5, 9, and 12 years postoperatively, respectively; these di fferences were not statistically significant. One year postoperatively, 91% of group A and 96% of group B patients reported their symptoms had improve d. However, patient satisfaction decreased at 5, 7, and 12 years postoperat ively, with 91%, 89%, and 66% of group A and 96%, 93%, and 68%, respectivel y, of group B patients reporting their symptoms had improved; these differe nces were not statistically significant. Postoperatively, most patients ret urned to full agricultural activity. Total knee arthroplasty, which was lat er required in 12% of the knees, was not significantly jeopardized by the p revious osteotomy.