Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2012 Apr;47(2):104-110. Korean.
    Published online Apr 30, 2012.
    https://doi.org/10.4055/jkoa.2012.47.2.104
    Copyright © 2012 by The Korean Orthopaedic Association
    Original Article

    Comparison of Closing-Wedge and Opening-Wedge High Tibial Osteotomies

    Se Hyun Cho, M.D., Ph.D., Sun Chul Hwang, M.D., Kang Min Sohn, M.D. and Hyung Kan Kim, M.D.
      • Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, Korea.
    • Correspondence to: Se Hyun Cho, M.D., Ph.D. Department of Orthopaedic Surgery, Gyeongsang National University Hospital, 90, Chiram-dong, Jinju 660-702, Korea. TEL: +82-55-750-8100, FAX: +82-55-755-8365, Email: shcho@gnu.kr
    Received June 24, 2011; Revised October 11, 2011; Accepted November 08, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The aim of this study is to compare the clinical results and radiologic changes of closing-wedge high tibial osteotomy (CW HTO) and opening-wedge high tibial osteotomy (OW HTO).

    Materials and Methods

    Seventy five knees were treated with a CW HTO and 41 with an OW HTO. For each patient the hip-knee-ankle (H-K-A) axis was evaluated and the degree of the medial compartmental arthrosis was measured by Ahlbäck-type radiological classification. The function of the knee was evaluated by the Tegner activity score, the Lysholm knee scoring scale and the Western Ontario and McMaster University index. Lateral radiographs were taken to assess the patellar height and the posterior tibial inclination.

    Results

    In both groups significant improvement of the visual analogue scale and range of motion was achieved. The frontal plane H-K-A axis was corrected significantly from varus to the range of physiological valgus and the arthrosis of the medial compartment of the knee progressed gradually. The body mass index was significantly influential to the progression of arthrosis. The functions of the knee were improved significantly in all cases. In the closing-wedge group, the patella height was increased at the postoperative period, while it was decreased in the opening-wedge group. There was a tendency of a decrease of the tibial inclination in the CW HTO group and a statistically significant increase of the tibial inclination in the OW HTO group. Recurrence of varus occurred in sixteen cases.

    Conclusion

    In both groups, improvement of the function of the knee was achieved, but there was no statistical difference. However, the opposite result was found in the patella height and the tibial inclination.

    Keywords
    high tibial osteotomy; closing-wedge high tibial osteotomy; opening-wedge high tibial osteotomy; compare

    Figures

    Figure 1
    Visual analogue scale score. Preop, preoperative; Postop, postoperative; CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy.

    Figure 2
    Preoperative and postoperative standing radiographs showing satisfactory correction of the varus deformity and the fixation of the osteotomy with 90 degree angled blade plate designed by Se-Hyun Cho. The final standing x-ray shows maintenance of the correction after removal of the hardware.

    Figure 3
    Preoperative varus gonarthrosis is well corrected by open wedge high tibial osteotomy fixed with anatomical plate.

    Figure 4
    Correction in the frontal plane hip-knee-ankle axis. CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative; f/u, follow-up.

    Figure 5
    Radiologic changes evaluated by Ahlbäck classification. CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative.

    Figure 6
    Tegner activity score. Preop, preoperative; Postop, postoperative; CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy.

    Figure 7
    Lysholm knee scoring scale. Preop, preoperative; Postop, postoperative; CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy.

    Figure 8
    Patella height. CWO, closing-wedge osteotomy; ISI, Insall-Salvati Index; BPI, Blackburne Peel Index; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative; f/u, follow-up.

    Figure 9
    Posterior slope. CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative; f/u, follow-up.

    References

      1. Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A. High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 2003;16:21–26.
      1. Cho SH, Park JT, Kim DH, Hwang SC. Conversion of total knee arthroplasty after high tibial osteotomy. J Korean Knee Soc 2008;20:38–43.
      1. Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y. Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2005;13:539–544.
      1. Ozalay M, Ozkoc G, Circi E, et al. The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2008;16:948–951.
      1. Ward SR, Powers CM. The influence of patella alta on patellofemoral joint stress during normal and fast walking. Clin Biomech (Bristol, Avon) 2004;19:1040–1047.
      1. Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 2007;89:1749–1755.
      1. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979;10:585–608.
      1. Weidow J, Cederlund CG, Ranstam J, Kärrholm J. Ahlbäck grading of osteoarthritis of the knee: poor reproducibility and validity based on visual inspection of the joint. Acta Orthop 2006;77:262–266.
      1. Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G. The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg 2005;125:638–643.
      1. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977;59:241–242.
      1. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101–104.
      1. Moore TM, Harvey JP Jr. Roentgenographic measurement of tibial-plateau depression due to fracture. J Bone Joint Surg Am 1974;56:155–160.
      1. Haddad FS, Bentley G. Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 2000;15:597–603.
      1. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 1993;75:196–201.
      1. Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 2003;85-A:469–474.
      1. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 1965;47:984–990.
      1. El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S. Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 2010;38:323–329.
      1. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA. 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 2005;87:1227–1232.
      1. Giagounidis EM, Sell S. High tibial osteotomy: factors influencing the duration of satisfactory function. Arch Orthop Trauma Surg 1999;119:445–449.
      1. Cho SH, Hwang SC, Park JS, Lee SH. Change of the patellar height and tibial inclination after opening- and closing-wedge high tibial osteotomy. J Korean Knee Soc 2010;22:193–199.
      1. Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 1989;71:245–248.
      1. Seil R, Müller B, Georg T, Kohn D, Rupp S. Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc 2000;8:231–236.
      1. Tigani D, Ferrari D, Trentani P, Barbanti-Brodano G, Trentani F. Patellar height after high tibial osteotomy. Int Orthop 2001;24:331–334.
      1. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 2005;33:378–387.
      1. Wright JM, Heavrin B, Begg M, Sakyrd G, Sterett W. Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 2001;14:163–173.
      1. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. Injury 2003;34 Suppl 2:B55–B62.
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    MeSH Terms
    Axis, Cervical Vertebra
    Body Mass Index
    Humans
    Knee
    Ontario
    Osteotomy
    Patella
    Postoperative Period
    Range of Motion, Articular
    Recurrence
    Metrics
    Share
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