J Korean Orthop Assoc.  2015 Oct;50(5):379-386. 10.4055/jkoa.2015.50.5.379.

Clinical Results after Medial Opening Wedge High Tibial Osteotomy in Medial Compartment Osteoarthritis of the Knee: TomoFix(R) versus Aescula(R) Plates

• Lee JH
• Park H
• Ko JH

• KMID: 2185100
• DOI: http://doi.org/10.4055/jkoa.2015.50.5.379

Abstract

PURPOSE
The purpose of this study was to compare the clinical and radiologic results of medial open wedge high tibial osteotomy (HTO) using either TomoFix(R) plate (group A) or Aescula(R) plate (group B) in patients with medial compartment osteoarthritis.
MATERIALS AND METHODS
Sixty-four consecutive patients who underwent HTO for medial compartmental osteoarthritis from 2008 were included. Mean follow-up duration was 37.1 months. Twenty men and 44 women with a mean age of 50 years (range, 41 to 62 years) were divided into group A (locking plate, n=20) and group B (spacer plate, n=44). Clinical results were evaluated using knee society rating system (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiological results were obtained by measuring the mechanical axis, posterior tibial slope, and medial joint space width preoperatively, 3 months postoperatively, and at the final follow-up.
RESULTS
In overall patients, the mechanical axis was corrected from 7.8degrees+/-2.4degrees of varus preoperatively to 1.9degrees+/-2.2degrees of valgus 3 months after HTO. At the final follow-up, the mechanical axis was to 2.1degrees+/-3.1degrees of valgus which showed no statistical difference in group A. However, loss of correction was observed at the final follow-up, at 0.1degrees+/-3.1degrees of valgus angulation in group B. The increase of the posterior tibial slope was significantly greater in group A than group B. The joint space width in both groups was improved at last follow-up. All clinical results showed improvement after HTO, with significantly improved KSS and WOMAC scores (p<0.001).
CONCLUSION
The overall clinical results after HTO for medial compartment osteoarthritis were satisfactory. A group of spacer plates needed for prolonged protective weight bearing and locking plate was effective in maintenance of correction.

Keyword

knee; medial compartment osteoarthritis; open wedge high tibial osteotomy; spacer plate; locking plate

MeSH Terms

Axis, Cervical Vertebra
Female
Follow-Up Studies
Humans
Joints
Knee*
Male
Ontario
Osteoarthritis*
Osteotomy*
Weight-Bearing

Figure

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  Figure 1 (A) The angle (*) formed by lines drawn from this coordinate to the center of the femoral head and talar dome is corrected. (B) The limb alignment was corrected by high tibial osteotomy with locking plate.

• 

  Figure 2 Long locking plate (A) and short spacer plate (B) were used for high tibial osteotomy. The locking plate used at least four proximal and distal screws. The spacer plate used 2 plates for anteromedial and posteromedial support. (C) Posterior tibial slope (†) formed by axis of tibia and tibial plateau.

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  Figure 3 (A) Cartilage lesion (Outerbridge grade IV) was shown at initial arthroscopy. (B) Cartilage lesion was completely healed on second-look arthroscopy.

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