103 / 242
103
Introduction
Surgical treatment of painful lateral
osteoarthritis for young and high demanding
patients still remains controversial. Lateral
osteoarthritis may be associated to valgus
deformity. Such deformity leads to excessive
loading on the lateral compartment and
progression of the degenerative changes. By
correcting the deformity, varus osteotomy
unloads the affected compartment and relieves
the pain.
As Puddu
et al.
said: “Which osteotomy for a
valgus knee?” [1]. Such procedure can be
performed either on the femur and the tibia.
Since the first report by Jackson and Waugh in
1961 [2], results of high tibial varus osteotomies
(HTVO) have been analysed only in five
clinical studies [3, 4, 5, 6, 7]. The authors stated
that tibial osteotomy in excessive valgus
deformity leads to joint line obliquity, instability
and unsuccessful results. Since then, varus
osteotomies were more commonly performed
on the femoral side.
The aim of our study was to report the long-
term results of medial closing wedge high tibial
osteotomy and to analyse the complication and
revision rate of such procedure.
Materials and methods
A consecutive series is reported of 31 HTVO in
30 patients. All the patients were operated by
the same senior surgeon between 1997 and
2011.
Inclusion criteria were symptomatic osteo
arthritis of the lateral compartment of the knee
and a minimum of 36 months of follow-up.
Exclusion criteria were HTVO after lateral
tibial plateau fracture, chronic ACL deficiency,
or overcorrected high tibial valgus osteotomy.
Contraindications were Rheumatoid arthritis,
preoperative tibiofemoral subluxation, osteo
arthritis of the medial compartment of the knee
(Ahlbäck > 1) [8].
Surgical Technique
The mechanical axis of the lower limb was
analyzed using bilateral full length standing
alignment film. Full weight-bearing antero
posterior views in full extension and at 30° of
flexion, lateral but also axial views were
performed to evaluate the status of the
tibiofemoral and patellofemoral compartment.
Closing wedge varus tibial
osteotomies: Surgical
technique and long term
results
N. Jan, P. Chambat, J.-M. Fayard