title: Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study.
abstract: In a randomised clinical trial in 50 patients with symptomatic osteoarthritis of the medial compartment of the knee, the clinical results of high tibial osteotomy (HTO) according to the open wedge osteotomy (OWO) and closed wedge osteotomy (CWO) were compared. In both groups locked plate fixation was used. Clinical and radiological assessments were performed preoperatively and after one year. Postoperative hip-knee-ankle (HKA) correction angles were monitored on standing leg X-rays. The effect of HTO on collateral laxity of the knee was measured with a specially designed varus-valgus device. The WOMAC osteoarthritis index, the modified knee society score (KS) and visual analogue scales (VAS) were used to assess symptoms of osteoarthritis, function, pain and patient satisfaction. At one-year follow-up we found accurate corrections in both groups and the planned correction angles were achieved. No loss of correction was observed. Furthermore, the medial collateral laxity and the patellar height significantly decreased after OWO. Significant improvements of WOMAC and KS scores were found in both groups. All patients had significantly less pain and were very satisfied with the results. Surgery time was significantly longer in the CWO group, and complications were more frequent in this group. Both techniques led to good and comparable clinical results. The choice of whether to perform an open or a closed wedge osteotomy may be based on preoperative patellar height or concomitant collateral laxity.
authors.affiliation: Department of Orthopedics and Traumatology, Meander Medical Center, Ringweg Randenbroek 110, 3816 CP, Amersfoort, The Netherlands. rda.gaasbeek@meandermc.nl
authors.forename: Robert D A
authors.initials: RD
authors.lastname: Gaasbeek
authors.forename: Loes
authors.initials: L
authors.lastname: Nicolaas
authors.forename: Willard J
authors.initials: WJ
authors.lastname: Rijnberg
authors.forename: Corne J M
authors.initials: CJ
authors.lastname: van Loon
authors.forename: Albert
authors.initials: A
authors.lastname: van Kampen
mesh_terms: D001178:Arthroplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D010329:Patella / Q000000981:diagnostic imaging / Q000473:pathology; D011183:Postoperative Complications; D011859:Radiography; D020127:Recovery of Function; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013977:Tibia / Q000601:surgery*
references.citation: Arthroscopy. 2003 Dec;19 Suppl 1:109-16
references.pmid: 14673428
references.citation: Acta Orthop Scand. 1999 Oct;70(5):473-7
references.pmid: 10622480
references.citation: J Bone Joint Surg Am. 1976 Oct;58(7):952-60
references.pmid: 977627
references.citation: J Bone Joint Surg Br. 2001 Nov;83(8):1111-5
references.pmid: 11764421
references.citation: J Bone Joint Surg Br. 2006 Nov;88(11):1454-9
references.pmid: 17075089
references.citation: Am J Knee Surg. 2001 Summer;14(3):163-73
references.pmid: 11491427
references.citation: J Bone Joint Surg Br. 1999 May;81(3):444-8
references.pmid: 10872363
references.citation: J Bone Joint Surg Br. 1990 Mar;72(2):238-44
references.pmid: 2312563
references.citation: J Knee Surg. 2003 Jan;16(1):21-6
references.pmid: 12568262
references.citation: Knee Surg Sports Traumatol Arthrosc. 2005 Nov;13(8):689-94
references.pmid: 15702355
references.citation: J Bone Joint Surg Am. 1989 Feb;71(2):245-8
references.pmid: 2918009
references.citation: Eur J Radiol. 1995 Nov;21(1):18-24
references.pmid: 8654454
references.citation: Clin Orthop Relat Res. 1990 Jun;(255):251-6
references.pmid: 2347159
references.citation: J Orthop Sci. 2001;6(6):493-7
references.pmid: 11793170
references.citation: J Rheumatol. 1988 Dec;15(12):1833-40
references.pmid: 3068365
references.citation: Knee Surg Sports Traumatol Arthrosc. 2002 May;10(3):169-76
references.pmid: 12012035
references.citation: J Bone Joint Surg Am. 1987 Mar;69(3):332-54
references.pmid: 3818700
references.citation: Knee. 2004 Dec;11(6):457-61
references.pmid: 15581764
references.citation: Clin Orthop Relat Res. 1989 Nov;(248):13-4
references.pmid: 2805470
references.citation: Int Orthop. 2010 Feb;34(2):217-23
references.pmid: 19189104
references.citation: Int Orthop. 2010 Feb;34(2):255-61
references.pmid: 19547973
references.citation: Knee Surg Sports Traumatol Arthrosc. 2005 Oct;13(7):539-44
references.pmid: 15645214
references.citation: J Bone Joint Surg Br. 2005 Sep;87(9):1227-32
references.pmid: 16129748
references.citation: Arch Orthop Trauma Surg. 1991;110(2):103-8
references.pmid: 2015131
references.citation: Arch Orthop Trauma Surg. 2005 Nov;125(9):638-43
references.pmid: 16133475