Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material

Surgical correction of bowed legs should be performed as early as possible. Overload osteoarthritis, even without significant varus deformity of the knee, is a further indication for open-wedge high-tibial osteotomy. Progression of damage to the joint surfaces due to overloading can be significantly retarded by realigning the extremity with the aim to, at least, reduce overload on the medial compartment to a value close to physiological. Significant improvement to open-wedge high-tibial osteotomy (OWHTO) has been made on two fronts: (a) by the use of a more appropriate surgical technique and (b) by promoting osteogenesis through an angular-stable fixation device with just the correct amount of elasticity. A retrospective study of 53 consecutive cases in which no interposition material was used to fill the wedge, with gap openings between 5 mm and 20 mm, showed that ossification of the gap always progressed from the lateral hinge towards the medial side. Standard radiographs showed 75% of the gap filled in with new bone within 6−18 months. In conclusion, we believe that open-wedge high-tibial osteotomy using the TomoFix® plate has proved to be successful in treating unicompartmental gonarthrosis, even without bone grafts or bone-substitute material.