Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee.
OBJECTIVE
The purpose of our study was to evaluate the complications, technique-related risks, and the clinical course of patients treated with high tibial osteotomy (HTO) for medial arthritis of the knee with varus malalignment.


METHODS
Forty-three of 46 consecutive patients (follow-up, 93.5%) treated with HTO using the TomoFix implant (Synthes, Solothurn, Switzerland) were followed-up for 24 months. Radiographic and clinical data were collected preoperatively as well as 6, 12, and 24 months after surgery using standard instruments (Lysholm and subjective International Knee Documentation Committee score).


RESULTS
Excellent and good results were achieved in 67.5% of patients. Thirty-seven patients (86.0%) reported clinical improvement at 24 months compared to preoperative status. Evaluation of the clinical course following HTO revealed a significant increase in function after 12 (P < .01) and 24 (P < .01), but not at 6 months (P = .336) after surgery. A further increase was found between 12 and 24 months (P = .017); 67.5% of the study population returned to their predisease sports activity level at 24 months after surgery. Except for 1 case of intra-articular fracture, no severe intraoperative complications were found. One case of nonunion that demanded additional surgery was observed.


CONCLUSIONS
HTO with an open-wedge technique using the TomoFix implant seems to be a safe and efficient procedure. Our data show that postoperative recovery is long, with a majority of patients not reaching a functional end-point by 6 or 12 months. In many patients, further improvement was found after 12 months, which might be related to a removal of the implant.


METHODS
Level IV, therapeutic case series.
Niemeyer
Philipp
P
Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany. philipp.niemeyer@uniklinik-freiburg.de
Koestler
Wolfgang
W
Kaehny
Christian
C
Kreuz
Peter C
PC
Brooks
Christopher J
CJ
Strohm
Peter C
PC
Helwig
Peter
P
Suedkamp
Norbert P
NP
D000328:Adult; D017760:Bone Malalignment / Q000150:complications / Q000601:surgery*; D001860:Bone Plates; D003161:Compartment Syndromes / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects; D010149:Postoperative Pain / Q000209:etiology; D011859:Radiography; D016896:Treatment Outcome