title: Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis.
abstract: BACKGROUND
  The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis.
  
  
  METHODS
  A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments.
  
  
  RESULTS
  In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan-Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients.
  
  
  CONCLUSIONS
  HTO has acceptable long-term clinical and functional results that should not be underestimated by orthopedic surgeons under pressure to perform arthroplasty operations.
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey. gokhanpolat7@gmail.com.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Polat
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
authors.forename: Halil İbrahim
authors.initials: Hİ
authors.lastname: Balcı
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
authors.forename: Mehmet Fevzi
authors.initials: MF
authors.lastname: Çakmak
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demirel
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Şen
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aşık
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001860:Bone Plates; D016267:External Fixators; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000379:methods* / Q000534:rehabilitation; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Closing wedge; External fixator; High tibial osteotomy; Long-term comparison; Medial compartment arthritis; Opening wedge