Abstract
Frontal plane malalignment of the lower extremity results in abnormal load distribution across the knee joint. Consequences of this increased stress may lead to compartmental osteoarthritis. High tibial osteotomy is well established for early osteoarthritis of the knee joint in middle-aged patients. We hypothesize that earlier realignment of the varus knee can be performed without undue risks and debilitation toward the young active patient and with good results in short-term follow-up. Open-wedge high tibia osteotomy using the Puddu plate was performed on eleven patients (19 knees) under 25 years of age for constitutional high tibia vara. The mechanical femorotibial angle (FTA) and Knee Society Knee Score (KSKS) were compared pre-operatively and 24 months post-operatively. The average FTA improved from +8.8 degrees (+5 – +16) to −0.1 (−2 – +5). The average KSKS improved from 74 (50–100) to 93 (60–100) and the function score improved from 84 (50–100) to 95 (60–100). Special concerns in this age group include unsightly cosmesis, and kneeling pain and discomfort. Open-wedge high tibia osteotomy provides a satisfactory solution for constitutional high tibia vara with minor morbidity on behalf of the patient in the short-term follow-up period.
Similar content being viewed by others
References
Aglietti P, Buzzi R, Vena LM et al (2003) High tibial valgus osteotomy for medial gonarthrosis: A 10- to 21-year study. J Knee Surg 16:21–26
Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn 277:7–72
Aydogdu S, Sur H (1997) High tibial osteotomy for varus deformity of more than 20 degrees. Rev Chir Orthop Reparatrice Appar Mot 84:439–446
Berman AT, Bosacco SJ, Kirshner S et al (1991) Factors influencing long-term results in high tibial osteotomy. Clin Orthop Relat Res 272:192–198
Billings A, Scott DF, Camargo MP et al (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg 82:70–79
Bombaci H, Canbora K, Onur G et al (2005) The effect of open-wedge osteotomy on the posterior tibial slope. Acta Orthop Traumatol Turc 39:404–410
Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ et al (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus closed-wedge technique. J Bone Joint Surg Br 87:1227–1232
Choi HR, Hasegawa Y, Kondo S et al (2001) High tibial osteotomy for varus gonarthrosis: A 10- to 24-year follow-up study. J Orthop Sci 6:493–497
Coventry MB (1979) Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin North America 10:191–210
Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg 75:196–201
Flamme CH, Ruhmann O, Schmolke S et al (2003) Long-term outcome following high tibial osteotomy with tension bend principle. Arch Orthop Trauma Surg 123:12–16
Goutallier D, Hernigou P, Medevielle D et al (1985) Long-term results of the treatment of medial femoro-tibial gonarthrosis by tibial valgisation osteotomy. outcome of 93 osteotomies after more than 10 years. Rev Rhum Mal Osteoartic 52:437–444
Habata T, Uematsu K, Hattori K et al (2006) High tibial osteotomy that does not cause recurrence of varus deformity for medial gonarthrosis. Knee Surg Sports Traumatol Arthrosc 14:962–967
Hanssen AD, Stuart MJ, Scott RD et al (2001) Surgical options for the middle-aged patient with osteoarthritis of the knee joint. Instr Course Lect 50:499–511
Hernborg JS, Nillsson BE (1977) The natural course of untreated osteoarthritis of the knee. Clin Orthop Relat Res 123:130–137
Hernigou P, Medevielle D, Debeyre J et al (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg 69:332–354
Hernigou P (1996) A 20-year follow-up study of internal gonarthrosis after tibial valgus osteotomy. Single versus repeated osteotomy. Rev Chir Orthop Reparatrice Appar Mot 82:241–250
Holden DL, James SL, Larson RL et al (1988) Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg 70:977–982
Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg 66:1040–1048
Jenny JY, Tavan A, Jenny G et al (1998) Long-term survival rate of tibial osteotomies for valgus gonarthrosis. Rev Chir Orthop Reparatrice Appar Mot 84:350–357
Kharrazi D, Chandler RW, Spitzer AI (2000) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Curr Opin Orthop 11:26–34
Krackow KA (2004) Proximal tibial osteotomy: where did you go? J Arthroplasty 19:5–8
Matthews LS, Goldstein SA, Malvitz TA et al (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res 229:193–200
Motycka T, Eggerth G, Landsiedl F (2000) The incidence of thrombosis in high tibial osteotomies with and without the use of a tourniquet. Arch Orthop Trauma Surg 120:157–159
Munjal S, Krackow KA (2005) The adult knee. In: Weinstein SL, Buckwalter JA (eds) Turek’s Orthopaedics: principles and their application, 6th edn. Lippincott Williams and Wilkins, Philadelphia, pp 616–621
Naudie D, Bourne RB, Rorabeck CH et al (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res 367:18–27
Odenbring S, Egund N, Hagstedt B et al (1991) Ten-year results of tibial osteotomy for medial gonarthrosis. The influence of overcorrection. Arch Orthop Trauma Surg 110:103–108
Odenbring S, Lindstrand A, Egund N et al (1991) Prognosis for patients with medial gonarthrosis. A 16-year follow-up study of 189 knees. Clin Orthop Relat Res 266:152–155
Odenbring S, Tjornstrand B, Egund N et al (1989) Function after tibial osteotomy for medial gonarthrosis below aged 50 years. Acta Orthop Scand 60:527–531
Papachristou G, Plessas S, Sourlas J et al (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:403–408
Rinonapoli E, Mancini GB, Corvaglia A et al (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study. Clin Orthop Relat Res 353:185–193
Salzmann GM, Ahrens P, Naal FD et al (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37:312–318
Spahn G (2004) Complications in high tibial (medial opening-wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653
Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg 85:469–474
Strecker W (2006) Planning analysis of knee-adjacent deformities. I. Frontal plane deformities. Oper Orthop Traumatol 18:259–272
Tjornstrand B, Hagstedt B, Persson BM (1978) Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee. J Bone Joint Surg 60:973–977
Turner RS, Griffiths H, Heatley FW (1993) The incidence of deep-vein thrombosis after upper tibial osteotomy. A venographic study. J Bone Joint Surg 75:942–944
Vojtassak J, Seliga J (2001) High tibial osteotomy and debridement of the knee joint in treatment of varotic gonarthrosis. Bratisl Lek Listy 102:470–472
Waugh W (1986) Tibial osteotomy in the management of osteoarthritis of the knee. Clin Orthop Relat Res 210:55–61
Weidenhielm L, Wykman A, Lundberg A et al (1993) Knee motion after tibial osteotomy for arthrosis. Kinematic analysis of 7 patients. Acta Orthop Scand 64:317–319
Wolfe F, Lane NE (2002) The longterm outcome of osteoarthritis: Rates and predictors of joint space narrowing in symptomatic patients with knee osteoarthritis. J Rheumatol 29:139–146
Wright JM, Heavrin B, Begg M et al (2001) Observations on patellar height following opening-wedge proximal tibial osteotomy. Am J Knee Surg 14:163–173
Yasuda K, Majima T, Tsuchida T et al (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Masrouha, K.Z., Sraj, S., Lakkis, S. et al. High tibial osteotomy in young adults with constitutional tibia vara. Knee Surg Sports Traumatol Arthrosc 19, 89–93 (2011). https://doi.org/10.1007/s00167-010-1148-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-010-1148-7