Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study

We analyzed the difference in angle-correction accuracy and initial stability between open-wedge (OWO) and closed-wedge tibial valgus osteotomy (CWO). Five fresh-frozen pairs of human cadaver lower limbs were used; their bone mineral density (BMD) was measured with DEXA and a planned 7° valgus osteotomy was performed, either with an open (right knees) or closed (left knees) technique. All knees for osteotomy were fixed with a rigid locked plate. In OWO, tricalcium phosphate (TCP) wedges were inserted. The knees were subjected to an increasing cyclic axial load until failure, while measuring the relative displacement of the bony segments with roentgen stereophotogrammetric analysis. The mean postoperative valgus correction angle was 9.5°±2.8° for CWO (over-correction of 2.5°) and 6.2°±2.0° for OWO (under-correction of 0.8°) (P =0.08). The data of displacement under load bearing showed no significant differences in rotations and translations in any direction. No significant correlation between BMD and the moment of failure was found (P =0.27). This study has shown that both methods gave an acceptable correction with a high variation of postoperative correction angles. There was a tendency for over-correction in the CWO group but no significant difference was found. There was no difference in initial stability between CWO and OWO with a rigid locked-plate fixation.