Abstract
In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39–76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18–60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5° genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations.
Similar content being viewed by others
References
Akamatsu Y, Koshino T, Saito T , Wada J (1997) Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy. Clin Orthop 334:207–214
Catagni MA, Guerreshi F, Ahmad TS, Cattaneo R (1994) Treatment of genu varum in medial compartment osteoarthritis of the knee using the ilizarov method. Orthop Clin North Am 23(5):509–514
Coventry MB, Ilstrup DM, Walrichs SL (1993) Proximal tibial osteotomy. A critical long-term follow-up study of eigthy-seven cases. J Bone Joint Surg (Am) 75(2):196–201
Debeyre J, Artigou JM (1972) Long-term results of 260 tibial osteotomies for frontal deviations of the knee. Rev Chir Orthop Reparatrice Appar Mot 58:335–339
Dutkowsky JP (1992) Miscellaneous nontraumatic disorders. In: Crenshaw AH (ed) Campbell’s operative orthopaedics, 8th edn. vol 3. Mosby, St. Louis, pp 2005–2057
Fischgrund J, Paley D, Suter C (1994) Variables affecting time to bone consolidation during limb lengthening. Clin Orthop 301:31–37
Hernborg JS, Nilsson BE (1977) The natural course of untreated osteoarthritis of the knee. Clin Orthop 123:130–137
Hernigou PH, Medeivelle D, Debjre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen years follow-up study. J Bone Joint Surg (Am) 69(3):332–354
Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br) 43(7):746–751
Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138
Magyar G, Toksvig-Larsen S, Lindstrand A (1999) Hemicallotasis open-wedge osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br) 81(3):449–451
Magyar G, Ahl TL, Vibe P, Toksvig-Larsen S, Lindstrand A (1999) Open-wedge osteotomy by hemicallotasis or the closed-wedge technique for osteoarthritis of the knee. J Bone Joint Surg (Br) 81(3):444–448
Murphy SB (1994) Tibial osteotomy for genu varum: indications, preoperative planning, and technique. Orthop Clin North Am 3:477–482
Nakamura E, Mizuta H, Kudo S, Takagi K, Sakamato K (2001) Open-wedge osteotomy of the proximal tibia with hemicallotasis. J Bone Joint Surg (Br) 83(8):1111–1115
Odenbring S, Lindstrand A, Egund N, Larsson J, Heddson B (1991) Prognosis for patients with medial gonarthrosis. A 16 year follow-up study of 189 knees. Clin Orthop 266:152–155
Paley D (1990) Problems, obsctacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop 250:81–104
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am, 35(3):425–465
Paley D, Maar DC, Herzenberg JE (1994) New concepts in high tibial osteotomy for medial compartment osteoarthritis. Orthop Clin North Am 25(3):483–498
Phillips MJ, Krachow KA (1998) High tibial osteotomy and distal femoral osteotomy for valgus or varus deformity around the knee. AAOS instructional course lectures 47:429–436
Puddu G (2003) Personal communication. International symposium on operative and biologic treatments in sport medicine, Colonia, 2003
Rinonapoli E, Mancini GB, Coruaglia A, Nusiello S (1998) Tibial osteotomy for varus gonarthrosis. Clin Orthop 353:185–193
Sen C, Kocaoglu M, Eralp L (2003) The advantages of circular external fixation used in high tibial ostetomy. Knee Surg Sports Traumatol Arthrosc 11(3):139–144
Shefelbine SJ, Simon U, Claes C et al (2005) Prediction of fracture callus mechanical properties using micro-CT images and voxel-based finite element analysis. Bone 36:480–488
Tetsworth K, Paley D (1994) Malalignment and degenerative arthropathy. Orthop Clin North Am 25(3):367–377
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Asik, M., Sen, C., Kilic, B. et al. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 14, 948–954 (2006). https://doi.org/10.1007/s00167-006-0074-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-006-0074-1