The Results of Open Wedge Proximal Tibial Osteotomy According to Bone Graft and Fracture of Lateral Cortex

Seo, Seung Suk; Kim, Chang Wan; Ha, Dong Jun; Lee, Chang Rack

Abstract

PURPOSE
The purposes of this study are to evaluate the clinical effect of open high tibial osteotomy for treating patients with early osteoarthritis with varus deformity and to determine the effect of a bone graft and fracture of the lateral cortex.
MATERIALS AND METHODS
This study reviewed 14 patients (17 cases) who had been diagnosed with osteoarthritis with accompanying varus deformity and who were treated with open high tibial osteotomy from May 2001 to May 2007. Every patient showed less than Kallgren-Lawrence Stage II. Bone grafts were performed in 13 of the 17 cases. Clinical evaluations and radiologic evaluations were performed. We divided the patients into two groups according to a bone graft in the cases with openings of less than 10mm and preservation of the lateral cortex, and we compared them according to the clinical and radiological results, respectively. The average period of follow up was 34 months (range: 12~96 months).
RESULTS
The Lysholm score improved from 59.9 preoperatively to 81.5 postoperatively and the HSS score improved from 62.9 to 85.3. The femoro-tibial angle was varus 7.8 degrees at preoperation, valgus 11.6 degrees on the immediate postoperative examination and valgus 10.5 degrees at follow up. The posterior tibial slope was 8.9 degrees at preoperation, 11.8 degrees at postoperation and 12.3 degrees at the last follow up. The Insall-Salvati ratio revealed no significant difference from 0.92 preoperatively to 0.94 postoperatively (p=0.82). There was no significant difference between the groups (p=0.47) on comparison of bone grafting or not for the patients with an opening of less than 10 mm. The group with a preserved lateral cortex showed better clinical results than the other group. However, there were no observed radiological differences (p>0.05).
CONCLUSION
Open high tibial osteotomy that's performed on patients with early osteoarthritis is a useful treatment option. We can conclude that a bone graft does not significant influence the result for the case with an opening less than 10 mm, and firm fixation is mandatory when the lateral cortex is fractured.