Volume 15 | Issue 2 | Apr-Jun 2020 | Page 8-15 | Eknath D Pawar, Dhiraj Vithal Sonawane, Angad Chikodi, Shaswat Mishra, Sagar Bansal, Sachin Khemkar
Authers: Eknath D Pawar , Dhiraj Vithal Sonawane , Angad Chikodi , Shaswat Mishra  , Sagar Bansal , Sachin Khemkar 
 Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Shaswat Mishra
Department of Orthopaedics, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.
The purpose of our study was to review functional outcome of patients with Medial compartment knee osteoarthritis (MCOA) operated with High Tibial Osteotomy (HTO)external fixator who were operated in a span of 3 years between 2017 to 2019.
Methods: Total 13 patients undergone with HTO fixator between 2017 to 2019, all are operated with Medial Open Wedge Osteotomy (MOWO). Male were 6 and female were 7 in our study. Right knee was 5 and left knee was 8. Mean age of patients was 48 years, patients were called and functional outcome measured in terms of Knee Society Score (KSS), Medial Proximal Tibial Angle (MPTA), Posterior Tibial Slope (PTS).
Results: Pre-op mean MPTA=82.9, Preop mean PTS=9.1.
Post-op mean MPTA=90.2, Post op mean PTS=9.9.
Conclusion: HTO with external fixator is highly reliable and productive in patients who has MCOA and Varus knee, but many a surgeon across globe generally go with Total Knee Arthroplasty (TKA)without a second thought of HTO fixator, which actually increases life span of knee joint. In a MCOA knee, HTO intervention postpones need of TKA. Due to accurate correction of axis and less error during operation with external fixator we went ahead with HTO external fixator and not with tomofix. Patient needs to get proper counselling regarding HTO external fixator.
Keywords: High tibial osteotomy, medial compartment knee osteoarthritis, medial open wedge osteotomy, external fixator.
1. F. Fraysse, J. Arnold, and D. Thewlis, “A method for concise reporting of joint reaction forces orientation during gait,” Journal of Biomechanics, vol. 49, no. 14, pp. 3538–3542, 2016.
2. Z. Chen, X. Zhang, M. M. Ardestani et al., “Prediction of in vivo joint mechanics of an artificial knee implant using rigid multi-body dynamics with elastic contacts,” Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, vol. 228, no. 6, pp. 564–575, 2014.
3. P. M. Jin and E. S. Holloway, “The young osteoarthritic knee: dilemmas in management,” BMC Medicine, vol. 11, no. 1, p. 14, 2013.
4. D. Pereira, E. Ramos, and J. Branco, “Osteoarthritis,” Acta M´edica Portuguesa, vol. 28, no. 1, pp. 99–106, 2014.
5. S. B. Abramson and M. Attur, “Developments in the scientific understanding of osteoarthritis,” Arthritis Research & 8erapy, vol. 11, no. 3, p. 227, 2009.
6. C. Mina, W. E. Garrett Jr., R. Pietrobon, R. Glisson, and L. Higgins, “High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee,” 8e American Journal of Sports Medicine, vol. 36, no. 5, pp. 949–955, 2008.
7. K. Messner and W. Maletius, “,e long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14- year clinical and radiographic follow-up in 28 young athletes,” Acta Orthopaedica Scandinavica, vol. 67, no. 2, pp. 165–168, 1996.
8. V. Morin, R. Pailhe, B. R. Duval et al., “Gait analysis following medial opening-wedge high tibial osteotomy,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 26, no. 6, pp. 1838– 1844, 2017.
9. Akizuki S, Yasukawa Y, Takizawa T. Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritis knees with eburnation?: a prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone. Arthroscopy 1997;13:9-17.
10. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. J Bone Joint Surg [Am] 1965;47-A:984-90.
11. Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis: a long-term follow-up study. J Bone Joint Surg [Am] 1984;66-A:1040-8.
12. Kettelkamp DB, Wenger DR, Chao EY, Thompson C. Results of proximal tibial osteotomy: the effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. J Bone Joint Surg [Am] 1976;58-A:952-60.
13. Yasuda K, Majima T, Tschuida T, Kaneda K. A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthritis. Clin Orthop 1992;282:186-95.
14. Majima T, Yasuda K, Katsuragi R, Kaneda K. Progression of joint arthrosis 10 to 15 years after high tibial osteotomy. Clin Orthop 2000;381:177-84.
15. Koshino T, Yoshido T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years’ followup results of high tibial valgus osteotomy for osteoarthritic knee. Knee 2004;11:439- 44.
16. Berman AT, Bosacco SJ, Kirschner S, Avolio A Jr. Factors influencing long-term results in high tibial osteotomy. Clin Orthop 1991;272:192-8.
17. Maquet P. The treatment of choice in osteoarthritis of the knee. Clin Orthop Relat Res. 1985; 192:108-12.
18. Akamatsu Y, Koshino T, Saito T, Wada J. Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy. Clin Orthop Relat Res. 1997; 334:207-14.
19. Jackson JP. Osteotomy for Osteoarthritis of the Knee. J Bone Joint Surg Br. 1958; 40(4):826.
20. Debeyre J, Patte D. Value of corrective osteotomies in the treatment of certain knee diseases with axial deviation. Rev Rhum Mal Osteoartic. 1962; 29: 722.
21. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten-to 20-year follow up. J Bone Joint Surg Br. 2008; 90: 592.
22. Naudie D, Bourne RB, Rorabeck CH, Boume TJ. The install Award. survivorship of the high tibial valgus osteotomy. A 10- to -22-year follow-up study. Clin Orthopp Relat Res. 1999:18.
23. Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, et al. Complication associated with opening wedge high tibial osteotomy- A review of the literature and 15 years of experience. Knee. 2016; 23: 276.
24. N. D. Reeves and F. L. Bowling, “Conservative biomechanical strategies for knee osteoarthritis,” Nature Reviews Rheumatology, vol. 7, no. 2, pp. 113–122, 2011.
25. K. Mine, T. Nakayama, S. Milanese, and K. Grimmer, “,e effectiveness of braces and orthoses for patients with knee osteoarthritis: a systematic review of Japanese-language randomised controlled trials,” Prosthetics and Orthotics International, vol. 41, no. 2, pp. 115–126, 2017.
26. T. Duivenvoorden, R. W. Brouwer, T. M. van Raaij, A. P. Verhagen, J. A. Verhaar, and S. M. Bierma-Zeinstra, “Braces and orthoses for treating osteoarthritis of the knee,” Cochrane Database of Systematic Reviews, vol. 125, no. 1, article CD004020, 2015.
27. R. Takeuchi, Y. Umemoto, M. Aratake et al., “A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee,” Journal of Orthopaedic Surgery and Research, vol. 5, no. 1, p. 65, 2010.
28. S. Saito, V. Gouttebarge, P. P. F. M. Kuijer, R. C. I. van Geenen, R. W. Poolman, and G. M. M. J. Kerkhoffs, “Return to sports and physical activity after total and unicondylar knee arthroplasty: a systematic review and meta-analysis,” Sports Medicine, vol. 46, no. 2, pp. 269–292, 2016.
29. Z. Cao, X. Mai, J. Wang, E. Feng, and Y. Huang, “Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: a systematic review and meta-analysis,” Journal of Arthroplasty, vol. 33, no. 3, pp. 952–959, 2017.
30. Y. S. Jeon, C. H. Ahn, and M. K. Kim, “Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA,” Journal of Orthopaedic Surgery, vol. 25, no. 1, article 2309499016684092, 2017.
31. M. B. Santoso and L. Wu, “Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review,” Journal of Orthopaedic Surgery and Research, vol. 12, no. 1, p. 50, 2017.
32. H. Sun, L. Zhou, F. Li, and J. Duan, “Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis,” 8e Journal of Knee Surgery, vol. 30, no. 2, pp. 158–165, 2017.
33. C. C. Prodromos, A. Amendola, and R. P. Jakob, “High tibial osteotomy: indications, techniques, and postoperative management,” Instructional Course Lectures, vol. 64, pp. 555–565, 2015.
34. C. Hui, L. J. Salmon, A. Kok et al., “Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee,” 8e American Journal of Sports Medicine, vol. 39, no. 1, pp. 64–70, 2011.
35. A. Schallberger, M. Jacobi, P. Wahl, G. Maestretti, and R. P. Jakob, “High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 19, no. 1, pp. 122–127, 2011.
36. D. Saragaglia, M. Blaysat, D. Inman, and N. Mercier, “Outcome of opening wedge high tibial osteotomy augmented with a biosorb wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up,” International Orthopaedics, vol. 35, no. 8, pp. 1151–1156, 2011.
37. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna, D, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010; 30: 131.
38. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg. 2011; 19: 590.
39. Hutchison CR, Cho B, Wong N, Agnidis Z, Gross AE. Proximal valgus tibial osteotomy for osteoarthritis of the knee. Instr Course Lect. 1999; 48: 131.
40. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br. 2008; 90(12):1548-57.
41. P. Aglietti, E. Rinonapoli, G. Stringa, and A. Taviani, “Tibial osteotomy for the varus osteoarthritic knee,” Clinical Orthopaedics and Related Research, no. 176, pp. 239–251, 1983.
42. A. Amendola and D. E. Bonasia, “Results of high tibial osteotomy: review of the literature,” International Orthopaedics, vol. 34, no. 2, pp. 155–160, 2010.
43. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12- 28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006; 452:91-6. 25.
44. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999; 367:18-27.
45. Gstöttner M, Pedross F, Liebensteiner M, Bach C. Longterm outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008; 128(1):111-5.
46. Ivarsson I, Myrnerts R, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br. 1990; 72(2):238-44.
47. Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res. 1990; 255:251-6.
48. Stuchin SA, Johanson NA, Lachiewicz PF, Mont MA. Surgical management of inflammatory arthritis of the adult hip and knee. Instr Course Lect. 1999; 48:93-109.
49. Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC. The role of joint load in knee stability. J Bone Joint Surg
50. Lee DC, Byun SJ. High Tibial Osteotomy. Knee Surg Relat Res. 2012; 24: 61.
51. Chahla J, Dean CS, Mitchell JJ, Moatshe G, Serra CR, et al. Medial Opening Wedge Proximal Tibial Osteotomy. Arthrosc Tech. 2016; 5: e919.
52. Arch Orthop Trauma Surg. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008; 128: 345.
53. Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006; 14: 149.
54. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J Br. 2014; 96: 1491.
55. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sportss Med. 2014; 42: 690.
56. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee surg sports traumatol Arthrosc. 2013; 21: 170.
57. A. A. Amis, “Biomechanics of high tibial osteotomy,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 21, no. 1, pp. 197–205, 2013.
58. Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res. 1990; 255:215-27.
59. Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am. 1987; 69(5):745-9.
60. Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am. 1994; 25(3):367-77.
61. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979; 10(3):585-608.
62. Iorio R, Healy WL. Unicompartmental arthritis of the knee. J Bone Joint Surg Am. 2003; 85-A (7):1351-64.
63. 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
64. M. S. Black, A. G. d’Entremont, R. G. McCormack, G. Hansen, D. Carr, and D. R. Wilson, “,e effect of wedge and tibial slope angles on knee contact pressure and kinematics following medial opening-wedge high tibial osteotomy,” Clinical Biomechanics, vol. 51, pp. 17–25, 2017.
65. S. J. Song and D. K. Bae, “Computer-assisted navigation in high tibial osteotomy,” Clinics in Orthopedic Surgery, vol. 8, no. 4, pp. 349–357, 2016.
66. El-Azabh,halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S. The effect of closed and open wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br.2008;90(9):1193-7
67. Nha KW, Kim HJ, Ahn HS, Lee DH. Change in Posterior Tibial Slope After Open-Wedge and Closed-Wedge High Tibial Osteotomy: A Meta-analysis. Am J Sports Med,2016.
|How to Cite this article: Pawar E D, Sonawane D V, Chikodi A, Mishra S, Bansal S, Khemkar S. Functional outcome in patients operated with High Tibial Osteotomy (HTO) medial open wedge osteotomy with HTO fixator in a prospective study. Journal of Trauma and Orthopaedic Surgery. April – Jun 2020;15(2):8-15.|