Skip to main content
SpringerLink
Log in

The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction: One hundred and eight patients with varus gonarthrosis were treated with high tibial osteotomy (HTO) in 2001. Fifty one patients received an open wedge osteotomy by using the ‘Puddu’ plate and 57 patients received a Coventry-type closing wedge osteotomy. For both groups the follow-up examination period was 22.5 months (253–1009 days). Material and Methods: To evaluate the study, radiological and subjective criteria as well as the Lysholm and the Tegner Activity Score were used. Altogether 84 % of the patients were included in the follow-up examination study. Results: In both groups a significant improvement of both scores were achieved. Both methods obtained safe and reproducible results for the correction considering the different operation techniques. There were no differences in outcome between the two methods. Satisfactory results were also achieved for early arthrosis of the femoropatellar and the lateral compartment. Conclusion: Open and closed wedge HTOs obtain significant improvement in patients with medial osteoarthritis of the knee. Using the right technique is very important for good results. For stabilization of the medial ligament we recommend the open wedge osteotomy. The patient should be informed about the routine removal of the metal plate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Adili A et al (2002) Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 10(3):169–176

    Article  PubMed  Google Scholar 

  2. Aglietti P et al (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21 year study. J Knee Surg 16(1):21–26

    PubMed  Google Scholar 

  3. Backstein D, Meisami B, Gross AE (2003) Patella baja after the modified Coventry-Maquet high tibial osteotomy. J Knee Surg 16(4):203–208

    PubMed  Google Scholar 

  4. Berman AT et al (1991) Factors influencing long-term results in high tibial osteotomy. Clin Orthop (272):192–198

  5. Billings A et al (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg Am 82(1):70–79

    PubMed  CAS  Google Scholar 

  6. Choi HR et al (2001) High tibial osteotomy for varus gonarthrosis: a 10- to 24 year follow-up study. J Orthop Sci 6(6):493–497

    Article  PubMed  CAS  Google Scholar 

  7. Coventry MB (1965) Osteotomy of the Upper Portion of the Tibia for Degenerative Arthritis of the Knee. A Preliminary Report. J Bone Joint Surg Am 47:984–990

    PubMed  CAS  Google Scholar 

  8. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75(2):196–201

    PubMed  CAS  Google Scholar 

  9. Flamme CH et al (1999) Primary stability of different implants used in conjunction with high tibial osteotomy. Arch Orthop Trauma Surg 119(7–8):450–455

    Article  PubMed  CAS  Google Scholar 

  10. Flamme CH et al (2003) Long-term outcome following high tibial osteotomy with tension bend principle. Arch Orthop Trauma Surg 123(1):12–16

    PubMed  Google Scholar 

  11. Fuchs S (1999) Value of alignment osteotomy of the proximal tibia in the endoprosthesis period. Z Orthop Ihre Grenzgeb 137(3):253–258

    Article  PubMed  CAS  Google Scholar 

  12. Giagounidis EM, Sell S (1999) High tibial osteotomy: factors influencing the duration of satisfactory function. Arch Orthop Trauma Surg 119(7–8):445–449

    Article  PubMed  CAS  Google Scholar 

  13. Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15(5):597–603

    Article  PubMed  CAS  Google Scholar 

  14. Hsu RW et al (1990) Normal axial alignment of the lower extremity and load- bearing distribution at the knee. Clin Orthop (255):215–227

  15. Insall J, Shoji H, Mayer V (1974) High tibial osteotomy. A five-year evaluation. J Bone Joint Surg Am 56(7):1397–1405

    PubMed  CAS  Google Scholar 

  16. Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 66(7):1040–1048

    PubMed  CAS  Google Scholar 

  17. 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):78–85

    PubMed  Google Scholar 

  18. Leutloff D, Tobian F, Perka C (2001) High tibial osteotomy for valgus and varus deformities of the knee. Int Orthop 25(2):93–96

    Article  PubMed  CAS  Google Scholar 

  19. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154

    Article  PubMed  CAS  Google Scholar 

  20. Magyar G et al (1999) Open-wedge osteotomy by hemicallotasis or the closed-wedge technique for osteoarthritis of the knee A randomised study of 50 operations. J Bone Joint Surg Br 81(3):444–448

    Article  PubMed  CAS  Google Scholar 

  21. Meding JB et al (2000) Total knee arthroplasty after high tibial osteotomy. Clin Orthop (375):175–84

  22. Nakamura E et al (2001) Open-wedge osteotomy of the proximal tibia hemicallotasis. J Bone Joint Surg Br 83(8):1111–1115

    Article  PubMed  CAS  Google Scholar 

  23. Naudie D et al (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to −22 year followup study. Clin Orthop (367):18–27

  24. Odenbring S et al (1990) Revision after osteotomy for gonarthrosis A 10–19 year follow-up of 314 cases. Acta Orthop Scand 61(2):128–130

    Article  PubMed  CAS  Google Scholar 

  25. Paley D (2002) In: Principles of Deformity Correction. Springer Verlag, Berlin Heidelberg New York

  26. Pascher A, Materna W, Windhager R (2003) Analysis of two different techniques of osteosynthesis in high tibial osteotomy. Z Orthop Ihre Grenzgeb 141(1):37–41

    Article  PubMed  CAS  Google Scholar 

  27. Rinonapoli E et al (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21 year followup study. Clin Orthop (353):185–193

  28. Sen C, Kocaoglu M, Eralp L (2003) The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up). Knee Surg Sports Traumatol Arthrosc 11(3):139–144

    PubMed  Google Scholar 

  29. Spahn G (2003) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg, online first, DOI: 10.1007/s00402-003-0588-7

  30. Staubli AE et al (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–B62

    Article  PubMed  Google Scholar 

  31. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop (198):43–9

  32. Tigani D et al (2001) Patellar height after high tibial osteotomy. Int Orthop 24(6):331–334

    Article  PubMed  CAS  Google Scholar 

  33. Weale AE, Lee AS, MacEachern AG (2001) High tibial osteotomy using a dynamic axial external fixator. Clin Orthop (382):154–167

  34. Westrich GH et al (1998) Patella height after high tibial osteotomy with internal fixation and early motion. Clin Orthop (354):169–174

  35. Wright JM et al (2001) Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 14(3):163–173

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors gratefully thank Robert Rimer, M.D., Royal Orthopaedic Hospital, Birmingham for revising the paper as a native speaking orthopedic surgeon. We also gratefully thank Mr. Martin Steuer (department of sports medicine, Hospital for sports injuries Hellersen) for the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Operative Orthopaedics and Sportstraumatology, Hospital for Sports Injuries Hellersen, Paulmannshoherstr.17, 58515, Luedenscheid, Germany

    S. Hoell & V. Stoll

  2. Westfaelische Wilhelms, Medical faculty, University Muenster, Muenster, Germany

    J. Suttmoeller

  3. Westfaelische Wilhelms University Muenster, University Hospital for General Orthopaedics, Muenster, Germany

    S. Fuchs & G. Gosheger

Authors
  1. S. Hoell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Suttmoeller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Stoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Gosheger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Hoell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoell, S., Suttmoeller, J., Stoll, V. et al. The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg 125, 638–643 (2005). https://doi.org/10.1007/s00402-005-0004-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-005-0004-6

Keywords

Search

Navigation