High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up.

BACKGROUND

We studied the results of sixty-four valgus-producing high tibial osteotomies performed with the use of a calibrated osteotomy cutting guide and rigid internal fixation, and followed by early motion, in fifty-six patients who had medial unicompartmental osteoarthritis and varus malalignment. Long-term studies have demonstrated that a high tibial osteotomy performed with staple fixation and followed by immobilization in a cast has an expected survival rate of approximately 85 percent at five years and 60 percent at ten years (in studies of ninety-five knees and 213 knees, respectively). To the best of our knowledge, there are no long-term reports on high tibial osteotomies performed with a calibrated osteotomy cutting guide and rigid internal fixation and followed by early motion.

METHODS

The indications for high tibial osteotomy were medial unicompartmental osteoarthritis and varus malalignment. A lateral closing-wedge osteotomy was performed. The patients were reexamined to obtain a knee score, to make lateral radiographs of both knees, and to make a full-length anteroposterior radiograph (showing the entire lower extremity, including the hip and ankle) of the involved knee with the patient standing.

RESULTS

Twenty-one knees were treated with a subsequent total knee arthroplasty at an average of sixty-five months after the high tibial osteotomy. The remaining forty-three knees had a good or excellent clinical result, with an average knee score of 94 points at an average of 8.5 years after the osteotomy. Survivorship analysis showed an expected rate of survival, with conversion to a total knee arthroplasty as the end point, of 85 percent at five years and 53 percent at ten years. No patient had patella baja postoperatively. There were six complications: four superficial wound infections, one superficial-vein thrombosis, and one delayed union (union occurred at five months).

CONCLUSIONS

High tibial osteotomy has been criticized because of a high rate of complications, a loss of effectiveness with time, and the difficulty of conversion to a total knee arthroplasty secondary to patella baja. In our series, in which an osteotomy was performed with a calibrated osteotomy cutting guide and rigid internal fixation and was followed by early motion, the rate of complications was low and approximately two-thirds of the knees had a good or excellent clinical result at an average of 8.5 years. Conversion to a total knee arthroplasty was accomplished without difficulty in the patients who had this procedure. We highly recommend high tibial osteotomy with a calibrated osteotomy cutting guide, rigid internal fixation, and early motion for patients who wish to continue an active lifestyle.