title: High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years.
abstract: OBJECTIVE
  High tibial osteotomy is a well-established method for the treatment of medial unicompartmental osteoarthritis of the knee.
  
  
  METHODS
  We analysed retrospectively the long-term outcome of open and closing wedge valgisation high tibial osteotomies. Out of 71 patients, 54 (76%) were available for the study. Survival rates and the influence of the osteotomy type were investigated. Secondary outcome measures were the course of radiological leg axis and osteoarthritis as well as score outcomes.
  
  
  RESULTS
  During a median follow-up of 16.5 years (IQR 14.5-17.9; range 13-21), 13 patients (24%) underwent conversion to total knee arthroplasty; the other 41 patients (76%, survivor group) were studied by score follow-up as well as clinical and radiological examinations. Osteotomy survival was of 98% after 5 years, 92% after 10 years and 71% after 15 years. Comparison between open and closing wedge high tibial osteotomy showed no significant difference in survival and score outcome. The median Visual Analogue Score (VAS) was 0 (IQR 0-1; range 0-4), the Satisfaction Index was 80% (IQR 63-89; range 30-100), the median Knee Injury and Osteoarthritis Outcome Score was 71 (IQR 49-82; range 9-100) and the median Western Ontario and McMaster Universities Osteoarthritis index was 84 (IQR 66-96; range 9-100). Radiological evaluation showed only a slight progression of the degree of osteoarthritis following the Kellgren and Lawrence classification. In each case, the axis passed through the healthy compartment or at least through the centre of the knee.
  
  
  CONCLUSIONS
  Open and closing wedge high tibial osteotomies are a successful choice of treatment for unicompartmental degenerative diseases with associated varus in active patients. Survival of both techniques is comparable in our series and is associated with low pain scores, high satisfaction and high activity levels of the survivors.
authors.affiliation: Department of Orthopaedic Surgery, Hôpital Cantonal Fribourg, 1708 Fribourg, Switzerland.
authors.forename: Alex
authors.initials: A
authors.lastname: Schallberger
authors.forename: Matthias
authors.initials: M
authors.lastname: Jacobi
authors.forename: Peter
authors.initials: P
authors.lastname: Wahl
authors.forename: Gianluca
authors.initials: G
authors.lastname: Maestretti
authors.forename: Roland P
authors.initials: RP
authors.lastname: Jakob
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D005500:Follow-Up Studies; D006801:Humans; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
references.citation: Orthopade. 2004 Feb;33(2):135-42
references.pmid: 14872304
references.citation: Clin Orthop Relat Res. 1992 Apr;(277):210-6
references.pmid: 1555344
references.citation: Knee. 2004 Dec;11(6):439-44
references.pmid: 15581761
references.citation: J Bone Joint Surg Am. 1973 Jan;55(1):23-48
references.pmid: 4691662
references.citation: Clin Orthop Relat Res. 1992 Sep;(282):186-95
references.pmid: 1516311
references.citation: J Bone Joint Surg Br. 2006 Feb;88(2):149-55
references.pmid: 16434514
references.citation: Clin Orthop Relat Res. 1998 Aug;(353):185-93
references.pmid: 9728173
references.citation: Acta Orthop. 2008 Apr;79(2):230-4
references.pmid: 18484249
references.citation: Clin Orthop Relat Res. 2006 Nov;452:91-6
references.pmid: 16906111
references.citation: Knee Surg Sports Traumatol Arthrosc. 2006 Mar;14(3):291-300
references.pmid: 16284740
references.citation: J Bone Joint Surg Am. 2007 Oct;89 Suppl 3:59-69
references.pmid: 17908871
references.citation: J Bone Joint Surg Br. 2008 Mar;90(3):265-71
references.pmid: 18310744
references.citation: J Bone Joint Surg Br. 2008 May;90(5):592-6
references.pmid: 18450624
references.citation: Clin Orthop Relat Res. 1997 Jan;(334):207-14
references.pmid: 9005915
references.citation: J Bone Joint Surg Am. 1993 Feb;75(2):196-201
references.pmid: 8423180
references.citation: J Rheumatol. 1988 Dec;15(12):1833-40
references.pmid: 3068365
references.citation: Knee Surg Sports Traumatol Arthrosc. 2003 May;11(3):132-8
references.pmid: 12774149
references.citation: J Bone Joint Surg Am. 2000 Jan;82(1):70-9
references.pmid: 10653086
references.citation: Injury. 2003 Nov;34 Suppl 2:B55-62
references.pmid: 14580986
references.citation: J Bone Joint Surg Am. 2003 Mar;85(3):469-74
references.pmid: 12637433
references.citation: Ann Rheum Dis. 1957 Dec;16(4):494-502
references.pmid: 13498604
references.citation: Clin Orthop Relat Res. 1989 Sep;(246):250-9
references.pmid: 2766613
references.citation: Arthroscopy. 2004 Apr;20(4):366-72
references.pmid: 15067275
references.citation: Bull Hosp Jt Dis. 2002-2003;61(1-2):58-62
references.pmid: 12828381
references.citation: Orthop Clin North Am. 1979 Jul;10(3):585-608
references.pmid: 460834
references.citation: J Orthop Sports Phys Ther. 1998 Aug;28(2):88-96
references.pmid: 9699158
references.citation: Int Orthop. 1979 Mar;3(1):37-45
references.pmid: 27743108
references.citation: J Rheumatol. 1982 Sep-Oct;9(5):768-9
references.pmid: 6184474
references.citation: Ther Umsch. 1996 Oct;53(10):790-6
references.pmid: 8966691
references.citation: Clin Orthop Relat Res. 1999 Oct;(367):18-27
references.pmid: 10546594
references.citation: Clin Biomech (Bristol, Avon). 2004 Nov;19(9):944-50
references.pmid: 15475127
references.citation: Arch Orthop Trauma Surg. 2005 Nov;125(9):638-43
references.pmid: 16133475
references.citation: J Bone Joint Surg Br. 1961 Nov;43-B:752-7
references.pmid: 14038135
references.citation: Arch Orthop Trauma Surg. 2008 Jan;128(1):111-5
references.pmid: 17828411
references.citation: Arthroscopy. 2002 Mar;18(3):272-8
references.pmid: 11877613