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Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 8/2014

01.12.2014 | Original Article

Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer

verfasst von: Faik Türkmen, Cem Sever, Burkay K. Kacıra, Mehmet Demirayak, Mehmet Ali Acar, Serdar Toker

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 8/2014

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Abstract

Purpose

Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee is directed to the lateral compartment with this procedure. A gap occurs on the proximal tibia while providing adequate correction. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing bone union problems or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.

Methods

We evaluated 41 MOWHTOs that have been performed between 2009 and 2012 with no use of any grafts or synthetic materials and spacer. Age of the patients ranged from 43 to 67. Thirty-five of the patients were females and three of them were males. The follow-up time was 6 months.

Results

Seven knees had opening at the osteotomy site <10 mm, 26 knees had 10–12.5 mm, and eight knees had >12.5 mm (range 7.5–14 mm, mean 11.07 mm). All osteotomies united without loss of correction. The mean bone union time was 12.8 weeks. We did not have any major complication regarding the technique.

Conclusion

The results of our study have shown that we can achieve satisfactory and good results by performing MOWHTO procedure without using any bone grafts or synthetic materials and spacer.
Literatur
1.
Zurück zum Zitat Franco V, Cerullo G, Cipolla M, Gianni E, Puddu G (2005) Osteotomy for osteoarthritis of the knee. Curr Orthop 19:415–427CrossRef Franco V, Cerullo G, Cipolla M, Gianni E, Puddu G (2005) Osteotomy for osteoarthritis of the knee. Curr Orthop 19:415–427CrossRef
2.
Zurück zum Zitat Zorzi AR, da Silva HG, Muszkat C, Marques LC, Cliquet A Jr, de Miranda JB (2011) Opening-wedge high tibial osteotomy with and without bone graft. Artif Organs 35(3):301–307PubMedCrossRef Zorzi AR, da Silva HG, Muszkat C, Marques LC, Cliquet A Jr, de Miranda JB (2011) Opening-wedge high tibial osteotomy with and without bone graft. Artif Organs 35(3):301–307PubMedCrossRef
3.
Zurück zum Zitat Klinger HM, Lorenz F, Härer T (2001) Open wedge tibial osteotomy by hemicallotasis for medial compartment osteoarthritis. Arch Orthop Trauma Surg 121(5):245–247PubMedCrossRef Klinger HM, Lorenz F, Härer T (2001) Open wedge tibial osteotomy by hemicallotasis for medial compartment osteoarthritis. Arch Orthop Trauma Surg 121(5):245–247PubMedCrossRef
4.
Zurück zum Zitat Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85-A(1):78–85PubMed Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85-A(1):78–85PubMed
5.
Zurück zum Zitat Kraal T, Mullender M, de Bruine JH, Reinhard R, de Gast A, Kuik DJ, van Royen BJ (2007) Resorbability of rigid beta-tricalcium phosphate wedges in open-wedge high tibial osteotomy: a retrospective radiological study. Knee 15(3):201–205CrossRef Kraal T, Mullender M, de Bruine JH, Reinhard R, de Gast A, Kuik DJ, van Royen BJ (2007) Resorbability of rigid beta-tricalcium phosphate wedges in open-wedge high tibial osteotomy: a retrospective radiological study. Knee 15(3):201–205CrossRef
6.
Zurück zum Zitat Sgaglione NA, Moynihan DP, Uggen C (2007) The use of allografts in high tibial osteotomy: opening wedge technique. Oper Tech Sports Med 15:72–80CrossRef Sgaglione NA, Moynihan DP, Uggen C (2007) The use of allografts in high tibial osteotomy: opening wedge technique. Oper Tech Sports Med 15:72–80CrossRef
7.
Zurück zum Zitat Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 19(9):944–950CrossRef Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 19(9):944–950CrossRef
8.
Zurück zum Zitat Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(Suppl 2):B55–B62PubMedCrossRef Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(Suppl 2):B55–B62PubMedCrossRef
9.
Zurück zum Zitat Dorsey WO, Miller BS, Tadje JP, Bryant CR (2006) The stability of three commercially available implants used in medial opening wedge high tibial osteotomy. J Knee Surg 19(2):95–98PubMed Dorsey WO, Miller BS, Tadje JP, Bryant CR (2006) The stability of three commercially available implants used in medial opening wedge high tibial osteotomy. J Knee Surg 19(2):95–98PubMed
10.
Zurück zum Zitat Niemeyer P, Koestler W, Kaehny C, Kreuz PC, Brooks CJ, Strohm PC, Helwig P, Suedkamp NP (2008) Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 24(7):796–804PubMedCrossRef Niemeyer P, Koestler W, Kaehny C, Kreuz PC, Brooks CJ, Strohm PC, Helwig P, Suedkamp NP (2008) Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 24(7):796–804PubMedCrossRef
11.
Zurück zum Zitat Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653PubMedCrossRef Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653PubMedCrossRef
12.
Zurück zum Zitat Spahn G, Mückley T, Kahl E, Hofmann GO (2006) Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech 21(3):272–278CrossRef Spahn G, Mückley T, Kahl E, Hofmann GO (2006) Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech 21(3):272–278CrossRef
13.
Zurück zum Zitat Amendola A, Panarella L (2005) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Orthop Clin N Am 36(4):497–504CrossRef Amendola A, Panarella L (2005) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Orthop Clin N Am 36(4):497–504CrossRef
14.
Zurück zum Zitat Brosset T, Pasquier G, Migaud H, Gougeon F (2011) Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 97(7):705–711PubMedCrossRef Brosset T, Pasquier G, Migaud H, Gougeon F (2011) Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 97(7):705–711PubMedCrossRef
15.
Zurück zum Zitat Levai JP, Bringer O, Descamps S, Boisgard S (2003) Xenograft-related complications after filling valgus open wedge tibial osteotomy defects. Rev Chir Orthop Reparatrice Appar Mot 89(8):707–711PubMed Levai JP, Bringer O, Descamps S, Boisgard S (2003) Xenograft-related complications after filling valgus open wedge tibial osteotomy defects. Rev Chir Orthop Reparatrice Appar Mot 89(8):707–711PubMed
16.
Zurück zum Zitat Warden SJ, Morris HG, Crossley KM, Brukner PD, Bennell KL (2005) Delayed- and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases. Knee Surg Sports Traumatol Arthrosc 13(1):34–37PubMedCrossRef Warden SJ, Morris HG, Crossley KM, Brukner PD, Bennell KL (2005) Delayed- and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases. Knee Surg Sports Traumatol Arthrosc 13(1):34–37PubMedCrossRef
17.
18.
Zurück zum Zitat Rose T, Imhoff AB (2007) Complications after transgenicular osteotomies. Oper Tech Orthop 17:80–86CrossRef Rose T, Imhoff AB (2007) Complications after transgenicular osteotomies. Oper Tech Orthop 17:80–86CrossRef
19.
Zurück zum Zitat Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13(4):279–289PubMed Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13(4):279–289PubMed
20.
Zurück zum Zitat Ganji R, Omidvar M, Izadfar A, Alavinia SM (2013) Opening wedge high tibial osteotomy using tibial wedge allograft: a case series study. Eur J Orthop Surg Traumatol 23(1):111–114PubMedCrossRef Ganji R, Omidvar M, Izadfar A, Alavinia SM (2013) Opening wedge high tibial osteotomy using tibial wedge allograft: a case series study. Eur J Orthop Surg Traumatol 23(1):111–114PubMedCrossRef
21.
Zurück zum Zitat Marti RK, Verhagen RA, Kerkhoffs GM, Moojen TM (2001) Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results. J Bone Joint Surg Am 83-A(2):164–170PubMed Marti RK, Verhagen RA, Kerkhoffs GM, Moojen TM (2001) Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results. J Bone Joint Surg Am 83-A(2):164–170PubMed
22.
Zurück zum Zitat Gomoll AH (2011) High tibial osteotomy for the treatment of unicompartmental knee osteoarthritis: a review of the literature, indications, and technique. Phys Sportsmed 39(3):45–54PubMedCrossRef Gomoll AH (2011) High tibial osteotomy for the treatment of unicompartmental knee osteoarthritis: a review of the literature, indications, and technique. Phys Sportsmed 39(3):45–54PubMedCrossRef
23.
Zurück zum Zitat Aryee S, Imhoff AB, Rose T, Tischer T (2008) Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 29(26):3497–3502PubMedCrossRef Aryee S, Imhoff AB, Rose T, Tischer T (2008) Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 29(26):3497–3502PubMedCrossRef
24.
Zurück zum Zitat Kuremsky MA, Schaller TM, Hall CC, Roehr BA, Masonis JL (2010) Comparison of autograft versus allograft in opening-wedge high tibial osteotomy. J Arthroplast 25(6):951–957CrossRef Kuremsky MA, Schaller TM, Hall CC, Roehr BA, Masonis JL (2010) Comparison of autograft versus allograft in opening-wedge high tibial osteotomy. J Arthroplast 25(6):951–957CrossRef
25.
Zurück zum Zitat Pollock R, Alcelik I, Bhatia C, Chuter G, Lingutla K, Budithi C, Krishna M (2008) Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques. Eur Spine J 17(6):845–852PubMedCentralPubMedCrossRef Pollock R, Alcelik I, Bhatia C, Chuter G, Lingutla K, Budithi C, Krishna M (2008) Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques. Eur Spine J 17(6):845–852PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Brull SJ, Lieponis JV, Murphy MJ, Garcia R, Silverman DG (1992) Acute and long-term benefits of iliac crest donor site perfusion with local anesthetics. Anesth Analg 74(1):145–147PubMed Brull SJ, Lieponis JV, Murphy MJ, Garcia R, Silverman DG (1992) Acute and long-term benefits of iliac crest donor site perfusion with local anesthetics. Anesth Analg 74(1):145–147PubMed
28.
Zurück zum Zitat Chae DJ, Shetty GM, Wang KH, Montalban AS Jr, Kim JI, Nha KW (2011) Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation. Knee 18(4):278–284PubMedCrossRef Chae DJ, Shetty GM, Wang KH, Montalban AS Jr, Kim JI, Nha KW (2011) Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation. Knee 18(4):278–284PubMedCrossRef
29.
Zurück zum Zitat Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 84-A(5):716–720PubMed Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 84-A(5):716–720PubMed
30.
Zurück zum Zitat van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB (2004) Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. Knee 11(6):451–456PubMedCrossRef van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB (2004) Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. Knee 11(6):451–456PubMedCrossRef
Metadaten
Titel
Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer
verfasst von
Faik Türkmen
Cem Sever
Burkay K. Kacıra
Mehmet Demirayak
Mehmet Ali Acar
Serdar Toker
Publikationsdatum
01.12.2014
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 8/2014
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-014-1417-0

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