High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion - Long-term follow-up

Background We studied the results of sixty-four valgus-producing high tibia l osteotomies performed with the use of a calibrated osteotomy cutting guid e and rigid internal fixation, and followed by early motion, in fifty-six p atients who had medial unicompartmental osteoarthritis and varus malalignme nt, Longterm studies have demonstrated that a high tibial osteotomy perform ed with staple fixation and followed by immobilization in a cast has an exp ected survival rate of approximately 85 percent at five years and 60 percen t at ten years tin studies of ninety-five knees and 213 knees, respectively ), To the best of our knowledge, there are no long-term reports on high tib ial osteotomies performed with a calibrated osteotomy cutting guide and rig id internal fixation and followed by early motion. Methods: The indications for high tibial osteotomy were medial unicompartme ntal osteoarthritis and varus malalignment, A lateral closing-wedge osteoto my was performed. The patients were reexamined to obtain a knee score, to m ake lateral radiographs of both knees, and to make a full-length anteropost erior radiograph (showing the entire lower extremity, including the hip and ankle) of the involved knee with the patient standing. Results: Twenty-one knees were treated with a subsequent total knee arthrop lasty at an average of sixty-five months after the high tibial osteotomy. T he remaining forty-three knees had a good or excellent clinical result,,vit h an average knee score of 94 points at an average of 8.5 years after the o steotomy, Survivorship analysis showed an expected rate of survival, with c on-version to a fetal knee arthroplasty as the end point, of 85 percent at five gears and 53 percent at ten years. No patient had patella baja postope ratively, There were six complications: four superficial wound infections, one superficial-vein thrombosis, and one delayed union (union occurred at f ive months). Conclusions: High tibial osteotomy has been criticized because of a high ra te of complications, a loss of effectiveness with time, and the difficulty of conversion to a fetal knee arthroplasty secondary to patella baja, In ou r series, in which an osteotomy was performed with a calibrated osteotomy c utting guide and rigid internal fixation and was followed by early motion, the rate of complications was low and approximately two-thirds of the knees had a good or excellent clinical result at an average of 8.5 years. Conver sion to a total knee arthroplasty was accomplished without difficulty in th e patients,who had this procedure. We highly recommend high tibial osteotom y with a calibrated osteotomy cutting guide, rigid internal fixation, and e arly motion for patients who wish to continue an active lifestyle.