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Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

01.01.2013 | Knee

A case series of lateral opening wedge high tibial osteotomy for valgus malalignment

verfasst von: Brett Collins, Alan Getgood, Abdulaziz Z. Alomar, J. Robert Giffin, Kevin Willits, Peter J. Fowler, Trevor B. Birmingham, Robert B. Litchfield

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 1/2013

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Abstract

Introduction

Lateral opening wedge high tibial osteotomy is a rarely employed surgical technique used for the treatment of lateral knee pain and degeneration in the setting of genu valgum. There exists little evidence of the suitability of this procedure for patients requiring osteotomies with a small correction.

Materials and methods

A case series of 23 patients (24 knees) undergoing lateral opening wedge high tibial osteotomy with a minimum follow-up of 2 years was performed between 2002 and 2008. A surgical technique avoiding the need for fibular osteotomy is described. Adverse events, patient-reported outcomes and radiographic measures of alignment were assessed at baseline, at 6 months postoperatively, and at time of final follow-up. A subgroup of 12 patients also underwent 3D gait analysis at the same time points.

Results

The mean follow-up was 52 months (±20.4). Statistically and clinically significant improvements were identified in the lower extremity functional scale [mean change (95 %CI) = 10 (2.4, 17.6)], and in the knee injury and osteoarthritis outcome score [mean change (95 %CI) = 10.9 (0.5, 21.4)]. Mechanical axis changed from 2.4 ± 2.4° valgus to 0 ± 2.6° varus (p<0.001), anatomical axis from 6.9 ± 2.8° to 4.7 ± 2.5° valgus (p < 0.001), with weight-bearing line offset changing from 60.2 ± 11.4 % to 49.5 ± 12.4 % (p < 0.001). Change in lateral tibial slope, from 6.5 ± 2.2° to 7.5 ± 2.3°, was very small and not statistically significant (n.s.). The peak knee adduction moment during gait significantly increased [mean change (95 %CI) = 0.72 %BW*Ht (0.42, 1.02), suggesting a medial shift in dynamic knee joint load. Two patients underwent total knee arthroplasty during the study period.

Conclusions

Lateral opening wedge high tibial osteotomy is a viable surgical option for patients with lateral knee pain and valgus malalignment requiring small degrees of correction.

Level of evidence

IV.

Ahlberg A, Scham S, Unander-Scharin L (1968) Osteotomy in degenerative and rheumatoid arthritis of the knee joint. Acta Orthop Scand 39(3):379–388PubMedCrossRef

Andriacchi TP, Mundermann A (2006) The role of ambulatory mechanics in the initiation and progression of knee arthritis. Curr Opin Rheumatol 18(5):514–518PubMedCrossRef

Binkley JM, Stratford PW, Lott SA, Riddle DL (1999) The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 79(4):371–383PubMed

Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, Jenkyn TR, Fowler PJ (2009) Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic and patient-reported outcomes. Arthritis Rheum 61(5):648–657PubMedCrossRef

Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Giffin JR (2007) Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis. Arthritis Rheum 57(6):1012–1017PubMedCrossRef

Bonnin M, Carret JP, Dimnet J, Dejour H (1996) The weight-bearing knee after anterior cruciate ligament rupture: an in vitro biomechanical study. Knee Surg Sports Traumatol Arthrosc 3(4):245–251PubMedCrossRef

Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RMD, Reijman M, Pols HAP, Bierma-Zeinstra SMA (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56:1204–1211PubMedCrossRef

Chao EY, Neluheni EV, Hsu RW, Paley D (1994) Biomechanics of malalignment. Orthop Clin North Am 25:379–386PubMed

Chambat P, Selmi TA, DeJour D, Denoyers J (2000) Varus tibial osteotomy. Oper Tech Sports Med 8:44–47CrossRef

10.

Cooke TD, Li J, Scudamore RA (1994) Radiographic assessment of bony contributions to knee deformity. Orthop Clin North Am 25:387–393PubMed

11.

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

12.

Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. J Bone Joint Surg Am 47:984–990PubMed

13.

Coventry MB (1987) Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. J Bone Joint Surg Am 69:32–38PubMed

14.

DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38(10):2077–2084PubMedCrossRef

15.

Di Fabio RP, Boissonnault W (1998) Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses. J Orthop Sports Phys Ther 27:219–230PubMed

16.

Drummond M (2001) Introducing economic and quality of life measurements into clinical studies. Ann Med 33(5):344–349PubMedCrossRef

17.

Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy: the effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264PubMed

18.

Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy or osteoarthritis of the knee: an arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608PubMed

19.

Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382PubMedCrossRef

20.

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

21.

Harding ML (1976) A fresh appraisal of tibial osteotomy for osteoarthritis of the knee. Clin Orthop Relat Res 114:223–234PubMed

22.

Healy WL, Anglen JO, Wasilewski SA, Krackow KA (1988) Distal femoral varus osteotomy. J Bone Joint Surg 70:102–109PubMed

23.

Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff A (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39(4):851–856PubMedCrossRef

24.

Hunt MA, Birmingham TB, Giffin JR, Jenkyn TR (2006) Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis. J Biomech 39:2213–2220PubMedCrossRef

25.

Jenkyn TR, Hunt MA, Jones IC, Giffin JR, Birmingham TB (2008) Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism. J Biomech 41:276–283PubMedCrossRef

26.

Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8:383–392PubMedCrossRef

27.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502PubMedCrossRef

28.

Kerkhoffs GMMJ, Rademakers MV, Altena M, Marti RK (2008) Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the Tibia. J Bone Joint Surg Am 90:1252–1257PubMedCrossRef

29.

Kirgis A, Albrecht S (1992) Palsy of the deep peroneal nerve after proximal tibial osteotomy. an anatomical study. J Bone Joint Surg Am 74:1180–1185PubMed

30.

Marti RK, Kerkhoffs GMMJ, Rademakers MV (2007) Correction of lateral tibial plateau depression and valgus malunion of the proximal Tibia. Oper Orthop Traumatol 19:101–113PubMedCrossRef

31.

Marti RK, Verhagen RAW, Kerkhoffs GMMJ, Moojen TM (2001) Proximal tibial varus osteotomy: indications, technique, and five to twenty-one-year results. J Bone Joint Surg Am 83:164–170PubMed

32.

Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S (2002) Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 61:617–622PubMedCrossRef

33.

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

34.

Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26(12):1607–1616PubMedCrossRef

35.

Paley D (2002) Principles of Deformity Correction. Springer-Verlag, New York

36.

Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465PubMed

37.

Puddu G, Cipolla M, Cerullo G, Franco V, Gianni E (2010) Which osteotomy for a valgus knee? Int Orthop 34:239–247PubMedCrossRef

38.

Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and osteoarthritis outcome score (KOOS): validation of a Swedish version. Scand J Med Sci Sports 8:439–448PubMedCrossRef

39.

Schiphof D, Boers M, Bierma-Zeinstra SM (2008) Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis 67(7):1034–1036PubMedCrossRef

40.

Seal PV, Chan RNW (1975) Tibial osteotomy for osteoarthritis of the knee: a five to ten year follow-up study. Acta Orthop Scand 46:141–151PubMedCrossRef

41.

Shoji H, Insall J (1973) High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg Am 55:963–973PubMed

42.

Specogna AV, Birmingham TB, DaSilva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2004) Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg 17(4):203–210PubMed

43.

Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis: survival and failure analysis the twenty-two years. J Bone Joint Surg Am 85A(3):469–474

44.

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

45.

Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRef

46.

Warme BA, Aalderink K, Amendola A (2011) Is there a role for high tibial osteotomies in the athlete? Sports Health 3:59–69PubMedCrossRef

47.

Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS (2005) Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain. J Orthop Sports Phys Ther 35(3):136–146PubMed

Titel: A case series of lateral opening wedge high tibial osteotomy for valgus malalignment
verfasst von: Brett Collins
Alan Getgood
Abdulaziz Z. Alomar
J. Robert Giffin
Kevin Willits
Peter J. Fowler
Trevor B. Birmingham
Robert B. Litchfield
Publikationsdatum: 01.01.2013
Verlag: Springer-Verlag
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 1/2013
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2070-y

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A case series of lateral opening wedge high tibial osteotomy for valgus malalignment