Assessment of open-wedge high tibial osteotomy plus tibial tubercle osteotomy: A novel approach for genu varum treatment

Document Type : Original Article

Authors

Department of Orthopedics, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Lower extremity genu varum is a common deformity leading to imbalanced weight distribution on the knee joint and eventually significant disabilities due to medial compartment joint osteoarthritis. This study was aimed to assess the efficacy of a novel technique of high tibial open wedge osteotomy plus tubercle osteotomy in a follow-up study. Materials and Methods: This is a prospective census cross-sectional study conducted on 146 patients with the history of genu varus undergone high tibial open-wedge osteotomy and tubercle osteotomy since 2011. The study population was followed within 6 months regarding tibial slope angle and medial proximal tibial angle alterations and operation-related complications, including venous phlebitis, nerve, and arterial injury, deep and superficial infection, mal-, non- and delayed-union. Results: 146 patients with the mean age of 25.66 ± 4.23 years, and predominance of male gender (60.3%) were evaluated. Mean of tibia slope and MPTA before the surgical procedure was 9.38 ± 0.85 and 79.45 ± 2.11 that turned to 7.10 ± 0.84 and 89.74 ± 1.52 postoperatively, respectively (P < 0.001). Arterial and peroneal nerve injury was not detected in any of the cases. Deep-vein phlebitis, superficial infection, and delayed-union, malunion, and nonunion were presented in 2.05%, 1.36%, and 2.05%, respectively. Conclusion: Outcomes of this study showed significant improvement in the tibia slope angle and MPTA postoperatively. Surgical-associated complications were negligible and rehabilitated by performing appropriate medical/surgical approaches. Considering the number of assessed population, HTO plus tubercle osteotomy seems an acceptable approach for genu varum treatment.

Keywords

1.
Strecker W. Planning analysis of knee-adjacent deformities: I. Frontal plane deformities. Eur J Trauma Emerg Surg 2007;33:662-8.  Back to cited text no. 1
    
2.
Heller M, Matziolis G, König C, Taylor W, Hinterwimmer S, Graichen H, et al. Musculoskeletal biomechanics of the knee joint. Der Orthopäde 2007;36:628-34.  Back to cited text no. 2
    
3.
Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P. The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: A biomechanical study. Arthroscopy 2007;23:852-61.  Back to cited text no. 3
    
4.
Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med 2004;32:60-70.  Back to cited text no. 4
    
5.
DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC. Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 2010;38:2077-84.  Back to cited text no. 5
    
6.
El-Assal MA, Khalifa YE, Abdel-Hamid MM, Said HG, Bakr HM. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc 2010;18:961-6.  Back to cited text no. 6
    
7.
Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 2009;25:46-53.  Back to cited text no. 7
    
8.
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;87:1227-32.  Back to cited text no. 8
    
9.
Haslam P, Armstrong M, Geutjens G, Wilton TJ. Total knee arthroplasty after failed high tibial osteotomy long-term follow-up of matched groups. J Arthroplasty 2007;22:245-50.  Back to cited text no. 9
    
10.
Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WC, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: A new technique. Knee 2004;11:457-61.  Back to cited text no. 10
    
11.
Shim JS, Lee SH, Jung HJ, Lee HI. High tibial open wedge osteotomy below the tibial tubercle: Clinical and radiographic results. Knee Surg Sports Traumatol Arthrosc 2013;21:57-63.  Back to cited text no. 11
    
12.
Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 1992;(274):248-64.  Back to cited text no. 12
    
13.
Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med 2000;28:282-96.  Back to cited text no. 13
    
14.
Tabrizi A. A short term follow up comparison of genuvarum corrective surgery using open and closed wedge high tibial osteotomy. Malays Orthop J 2013;7:7.  Back to cited text no. 14
    
15.
Canale ST, Beaty JH. Campbell's Operative Orthopaedics. Philadelphia; The United States: Elsevier Health Sciences; 2012.  Back to cited text no. 15
    
16.
Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 2010;34:305-9.  Back to cited text no. 16
    
17.
Park H, Kim HW, Kam JH, Lee DH. Open wedge high tibial osteotomy with distal tubercle osteotomy lessens change in patellar position. BioMed Res Int 2017;2017(1):1-10.  Back to cited text no. 17