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Erschienen in: Arthroskopie 3/2012

01.08.2012 | Leitthema

Hohe tibiale Osteotomie bei Varusgonarthrose

Indikation, Technik, Ergebnisse

verfasst von: S. Hinterwimmer, M.J. Feucht, A.B. Imhoff

Erschienen in: Arthroskopie | Ausgabe 3/2012

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Zusammenfassung

Die hohe tibiale Osteotomie (HTO) ist eine erfolgreiche und seit mehreren Jahrzehnten etablierte Behandlungsmethode der Varusgonarthrose. Daneben wird diese Operation auch erfolgreich zur Therapie der schmerzhaften medialen Überlastung, in Kombination mit Knorpelersatztherapien und bei chronischen Bandinstabilitäten eingesetzt. Die valgisierende Open-wedge-Technik hat seit der Einführung winkelstabiler Plattenfixateure die Closed-wedge-Technik als Goldstandard abgelöst. In dieser Arbeit wird ein differenziertes Schema zur Indikationsstellung und Korrekturplanung vorgestellt, welches sich an der zugrunde liegenden Pathologie des Patienten orientiert. Die von uns angewandte Technik der medialen Open-wedge-HTO wird detailliert beschrieben und ein Überblick über die bisherigen Ergebnisse unter besonderer Berücksichtigung von Langzeitüberlebensraten gegeben. Abschließend werden noch einige Besonderheiten dieser Operation, wie z. B. Änderungen von Slope und Patellahöhe, Osteotomien bei Gelenkinstabilität, Pseudarthrosenrate und Einfluss des Alters auf das Operationsergebnis, abgehandelt.
Literatur
1.
Zurück zum Zitat Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584PubMedCrossRef Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584PubMedCrossRef
2.
Zurück zum Zitat Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861PubMedCrossRef Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861PubMedCrossRef
3.
Zurück zum Zitat Akamatsu Y, Mitsugi N, Mochida Y et al (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593PubMedCrossRef Akamatsu Y, Mitsugi N, Mochida Y et al (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593PubMedCrossRef
4.
Zurück zum Zitat Akizuki S, Shibakawa A, Takizawa T et al (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596PubMedCrossRef Akizuki S, Shibakawa A, Takizawa T et al (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596PubMedCrossRef
5.
Zurück zum Zitat Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160PubMedCrossRef Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160PubMedCrossRef
6.
Zurück zum Zitat Brinkman JM, Lobenhoffer P, Agneskirchner JD et al (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557PubMedCrossRef Brinkman JM, Lobenhoffer P, Agneskirchner JD et al (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557PubMedCrossRef
7.
Zurück zum Zitat Brouwer RW, Bierma-Zeinstra SM, Koeveringe AJ van, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87:1227–1232PubMedCrossRef Brouwer RW, Bierma-Zeinstra SM, Koeveringe AJ van, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87:1227–1232PubMedCrossRef
8.
Zurück zum Zitat Chae DJ, Shetty GM, Lee DB et al (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133PubMedCrossRef Chae DJ, Shetty GM, Lee DB et al (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133PubMedCrossRef
9.
Zurück zum Zitat Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13:87–92PubMedCrossRef Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13:87–92PubMedCrossRef
10.
Zurück zum Zitat El-Azab H, Glabgly P, Paul J et al (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38:323–329PubMedCrossRef El-Azab H, Glabgly P, Paul J et al (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38:323–329PubMedCrossRef
11.
Zurück zum Zitat El-Azab H, Halawa A, Anetzberger H et al (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90:1193–1197PubMedCrossRef El-Azab H, Halawa A, Anetzberger H et al (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90:1193–1197PubMedCrossRef
12.
Zurück zum Zitat Feucht MJ, Mauro CS, Brucker PU et al (2012) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc Feucht MJ, Mauro CS, Brucker PU et al (2012) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc
13.
Zurück zum Zitat Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608PubMed Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608PubMed
14.
Zurück zum Zitat Giffin JR, Stabile KJ, Zantop T et al (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35:1443–1449PubMedCrossRef Giffin JR, Stabile KJ, Zantop T et al (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35:1443–1449PubMedCrossRef
15.
Zurück zum Zitat Giffin JR, Vogrin TM, Zantop T et al (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382PubMedCrossRef Giffin JR, Vogrin TM, Zantop T et al (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382PubMedCrossRef
16.
Zurück zum Zitat Hankemeier S, Hufner T, Wang G et al (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921PubMedCrossRef Hankemeier S, Hufner T, Wang G et al (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921PubMedCrossRef
17.
Zurück zum Zitat Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9:15–20PubMedCrossRef Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9:15–20PubMedCrossRef
18.
Zurück zum Zitat Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354PubMed Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354PubMed
19.
Zurück zum Zitat Hinterwimmer S, Beitzel K, Paul J et al (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39:851–856PubMedCrossRef Hinterwimmer S, Beitzel K, Paul J et al (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39:851–856PubMedCrossRef
20.
Zurück zum Zitat Hinterwimmer S, Rauch A, Kohn L, Imhoff AB (2012) High tibial osteotomy for anteromedial or posterolateral knee instability. Arthroskopie 23:14–22CrossRef Hinterwimmer S, Rauch A, Kohn L, Imhoff AB (2012) High tibial osteotomy for anteromedial or posterolateral knee instability. Arthroskopie 23:14–22CrossRef
21.
Zurück zum Zitat Hohmann E, Bryant A, Imhoff AB (2006) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc 14:454–459PubMedCrossRef Hohmann E, Bryant A, Imhoff AB (2006) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc 14:454–459PubMedCrossRef
22.
Zurück zum Zitat Hui C, Salmon LJ, Kok A et al (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39:64–70PubMedCrossRef Hui C, Salmon LJ, Kok A et al (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39:64–70PubMedCrossRef
23.
Zurück zum Zitat Hunt MA, Fowler PJ, Birmingham TB et al (2006) Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 49:401–406PubMed Hunt MA, Fowler PJ, Birmingham TB et al (2006) Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 49:401–406PubMed
24.
Zurück zum Zitat Kohn L, Sauerschnig M, Iskansar S et al (2012) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc (accepted) Kohn L, Sauerschnig M, Iskansar S et al (2012) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc (accepted)
25.
Zurück zum Zitat LaPrade RF, Oro FB, Ziegler CG et al (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170PubMedCrossRef LaPrade RF, Oro FB, Ziegler CG et al (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170PubMedCrossRef
26.
Zurück zum Zitat Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138PubMed Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138PubMed
27.
Zurück zum Zitat Luites JW, Brinkman JM, Wymenga AB, Heerwaarden RJ van (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 91:1459–1465PubMed Luites JW, Brinkman JM, Wymenga AB, Heerwaarden RJ van (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 91:1459–1465PubMed
28.
Zurück zum Zitat Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372PubMedCrossRef Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372PubMedCrossRef
29.
Zurück zum Zitat Meidinger G, Imhoff AB, Paul J et al (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19:333–339PubMedCrossRef Meidinger G, Imhoff AB, Paul J et al (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19:333–339PubMedCrossRef
30.
Zurück zum Zitat Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res (246):250–259 Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res (246):250–259
31.
Zurück zum Zitat Muller M, Strecker W (2008) Arthroscopy prior to osteotomy around the knee? Arch Orthop Trauma Surg 128:1217–1221PubMedCrossRef Muller M, Strecker W (2008) Arthroscopy prior to osteotomy around the knee? Arch Orthop Trauma Surg 128:1217–1221PubMedCrossRef
32.
Zurück zum Zitat Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to −22-year followup study. Clin Orthop Relat Res (367):18–27 Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to −22-year followup study. Clin Orthop Relat Res (367):18–27
33.
Zurück zum Zitat Naudie DD, Amendola A, Fowler PJ (2004) Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med 32:60–70PubMedCrossRef Naudie DD, Amendola A, Fowler PJ (2004) Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med 32:60–70PubMedCrossRef
34.
Zurück zum Zitat Niemeyer P, Schmal H, Hauschild O et al (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 26:1607–1616PubMedCrossRef Niemeyer P, Schmal H, Hauschild O et al (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 26:1607–1616PubMedCrossRef
35.
Zurück zum Zitat Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387PubMedCrossRef Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387PubMedCrossRef
36.
Zurück zum Zitat Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757 Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757
37.
Zurück zum Zitat Paley D, Pfeil J (2000) Principles of deformity correction around the knee. Orthopade 29:18–38PubMed Paley D, Pfeil J (2000) Principles of deformity correction around the knee. Orthopade 29:18–38PubMed
38.
Zurück zum Zitat Pape D, Lorbach O, Schmitz C et al (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211PubMedCrossRef Pape D, Lorbach O, Schmitz C et al (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211PubMedCrossRef
39.
Zurück zum Zitat Pape D, Seil R, Adam F et al (2004) Imaging and preoperative planning of osteotomy of tibial head osteotomy. Orthopade 33:122–134PubMedCrossRef Pape D, Seil R, Adam F et al (2004) Imaging and preoperative planning of osteotomy of tibial head osteotomy. Orthopade 33:122–134PubMedCrossRef
40.
Zurück zum Zitat Petrigliano FA, Suero EM, Voos JE et al (2012) The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee. Am J Sports Med 40(6):1322–1328PubMedCrossRef Petrigliano FA, Suero EM, Voos JE et al (2012) The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee. Am J Sports Med 40(6):1322–1328PubMedCrossRef
41.
Zurück zum Zitat Reichwein F, Nebelung W (2007) High tibial flexion osteotomy for revision of posterior cruciate ligament instability. Unfallchirurg 110:597–602PubMedCrossRef Reichwein F, Nebelung W (2007) High tibial flexion osteotomy for revision of posterior cruciate ligament instability. Unfallchirurg 110:597–602PubMedCrossRef
42.
Zurück zum Zitat Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19:590–599PubMed Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19:590–599PubMed
43.
Zurück zum Zitat Salzmann GM, Ahrens P, Naal FD et al (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37:312–318PubMedCrossRef Salzmann GM, Ahrens P, Naal FD et al (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37:312–318PubMedCrossRef
44.
Zurück zum Zitat Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb(R) wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156PubMedCrossRef Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb(R) wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156PubMedCrossRef
45.
Zurück zum Zitat Schaefer TK, Majewski M, Hirschmann MT, Friederich NF (2008) Comparison of sagittal and frontal plane alignment after open- and closed-wedge osteotomy: a matched-pair analysis. J Int Med Res 36:1085–1093PubMed Schaefer TK, Majewski M, Hirschmann MT, Friederich NF (2008) Comparison of sagittal and frontal plane alignment after open- and closed-wedge osteotomy: a matched-pair analysis. J Int Med Res 36:1085–1093PubMed
46.
Zurück zum Zitat Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368PubMedCrossRef Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368PubMedCrossRef
47.
Zurück zum Zitat Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartilage 14:190–195PubMedCrossRef Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartilage 14:190–195PubMedCrossRef
48.
Zurück zum Zitat Sterett WI, Miller BS, Joseph TA et al (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22:13–16PubMedCrossRef Sterett WI, Miller BS, Joseph TA et al (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22:13–16PubMedCrossRef
49.
Zurück zum Zitat Tigani D, Ferrari D, Trentani P et al (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334PubMedCrossRef Tigani D, Ferrari D, Trentani P et al (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334PubMedCrossRef
50.
Zurück zum Zitat Wright JM, Heavrin B, Begg M et al (2001) Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 14:163–173PubMed Wright JM, Heavrin B, Begg M et al (2001) Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 14:163–173PubMed
Metadaten
Titel
Hohe tibiale Osteotomie bei Varusgonarthrose
Indikation, Technik, Ergebnisse
verfasst von
S. Hinterwimmer
M.J. Feucht
A.B. Imhoff
Publikationsdatum
01.08.2012
Verlag
Springer-Verlag
Erschienen in
Arthroskopie / Ausgabe 3/2012
Print ISSN: 0933-7946
Elektronische ISSN: 1434-3924
DOI
https://doi.org/10.1007/s00142-012-0697-9

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