Skip to main content
SpringerLink
Log in

Valgisierende Tibiakopfosteotomie in öffnender Technik

Medial opening wedge high tibial osteotomy

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Druckreduktion des medialen Kompartiments bei Patienten mit medialer Varusgonarthrose und Entlastung v. a. der posterolateralen Bandstrukturen bei Varusdeformität und komplexen Bandinstabilitäten.

Indikationen

Mediale Varusgonarthrose bei noch gut erhaltenem lateralen und patellofemoralen Gelenkabschnitt. Komplexe Bandinstabilitäten bei gleichzeitig vorliegender Varusdeformität.

Kontraindikationen

Erhebliche Bewegungseinschränkungen

Operationstechnik

Mediale Hautinzision am proximalen Unterschenkel. Darstellung des Pes anserinus. Markierung der Osteotomie vom tiefsten Punkt der medialen Metaphyse ansteigend nach lateral. Biplanare Stufenosteotomie unter Schutz der posterioren neurovaskulären Strukturen mit ventraler Ausleitung der Osteotomie nach proximal der Tuberositas tibiae oder nach distal in Abhängigkeit von Begleitpathologien. Fixation mit winkelstabilem Plattenfixateur.

Weiterbehandlung

Im Grundsatz ist eine frühe Belastung bei Verwendung eines winkelstabilen Plattenfixateurs möglich. Oft erfordern jedoch Begleitpathologien wie z. B. eine begleitende knorpelregenerative Therapie eine längere Entlastungsphase. Die Beweglichkeit kann bei alleiniger Osteotomie ebenfalls früh freigegeben werden. Eine orthetische Versorgung ist für viele Fälle empfohlen.

Ergebnisse

Bei korrekter Indikationsstellung lassen sich unter der Voraussetzung einer standardisierten Operationstechnik mit der Open-Wedge-Osteotomie (OW-HTO) – trotz statistisch vergleichsweise hoher Komplikationsrate – gute Ergebnisse mit hoher Patientenzufriedenheit erzielen. Ein tendenziell schlechteres Outcome zeigen Patienten mit Body-Mass-Index über 30 und höheren Arthrosegraden.

Abstract

Objective

Reduction of the load to the medial compartment in patients with medial knee osteoarthritis and varus malalignment. Unloading of the posterolateral complex in varus deformity with complex ligamentous laxity.

Indications

Medial knee osteoarthritis and varus malalignment with largely intact lateral and patellofemoral joint aspect. Complex ligament insufficiency combined with varus deformity.

Contraindications

Substantially impaired range of motion.

Surgical technique

Medial skin incision on the proximal lower leg. Preparation of the pes anserinus. Marking of the osteotomy from the deepest point of the medial metaphysis laterally ascending. Biplane osteotomy, carefully protecting the posterior neurovascular structures, with ventral completion proximal or distal to the tibial tuberosity, depending on concomitant pathologies. Angular-stable plate fixation.

Postoperative management

In general, early weight bearing is possible when angular-stable plate fixation is used. Often concomitant pathologies such as accompanying cartilage regenerative therapy necessitate longer unloading. Range of motion does not need to be restricted following stand-alone osteotomy. Orthoses are recommended regularly.

Results

Under the correct indication, the medial opening wedge high tibial osteotomy (OW-HTO) technique can achieve good results with high patient satisfaction, despite a relatively high statistical complication rate, provided that a standardized surgical technique is used. There is a tendency for a poorer outcome in patients with a body mass index above 30 and higher stages of osteoarthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9

Literatur

  1. Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(3):291–300

    Article  CAS  PubMed  Google Scholar 

  2. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23(8):852–861

    Article  PubMed  Google Scholar 

  3. Amendola A, Panarella L (2005) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Orthop Clin North Am 36(4):497–504

    Article  PubMed  Google Scholar 

  4. Anagnostakos K, Mosser P, Kohn D (2013) Infections after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):161–169

    Article  PubMed  Google Scholar 

  5. Bode G, Ogon P, Pestka J et al (2015) Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 39:689–696

    Article  PubMed  Google Scholar 

  6. Bode G, von Heyden J, Pestka J et al (2015) Prospective 5‑year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23:1949–1955

    Article  PubMed  Google Scholar 

  7. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87(9):1227–1232

    Article  CAS  PubMed  Google Scholar 

  8. Cantin O, Magnussen RA, Corbi F, Servien E, Neyret P, Lustig S (2015) The role of high tibial osteotomy in the treatment of knee laxity: a comprehensive review. Knee Surg Sports Traumatol Arthrosc 23(10):3026–3037

    Article  CAS  PubMed  Google Scholar 

  9. Diffo Kaze A, Maas S, Waldmann D, Zilian A, Dueck K, Pape D (2015) Biomechanical properties of five different currently used implants for open-wedge high tibial osteotomy. J Exp Orthop 2(1):14

    Article  PubMed  PubMed Central  Google Scholar 

  10. El Amrani MH, Levy B, Scharycki S, Asselineau A (2010) Patellar height relevance in opening-wedge high tibial osteotomy. Orthop Traumatol Surg Res 96(1):37–43

    Article  PubMed  Google Scholar 

  11. Feucht MJ, Minzlaff P, Saier T, Cotic M, Sudkamp NP, Niemeyer P, Imhoff AB, Hinterwimmer S (2014) Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 38(11):2273–2280

    Article  PubMed  Google Scholar 

  12. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180

    Article  PubMed  Google Scholar 

  13. Floerkemeier S, Staubli AE, Schroeter S et al (2014) Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and  thirty three patients. Int Orthop 38:55–60

    Article  PubMed  Google Scholar 

  14. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10(3):585–608

    CAS  PubMed  Google Scholar 

  15. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW (2013) A „safe zone“ in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 21(1):90–95

    Article  CAS  PubMed  Google Scholar 

  16. Hinterwimmer S, Feucht MJ, Paul J, Kirchhoff C, Sauerschnig M, Imhoff AB, Beitzel K (2016) Analysis of the effects of high tibial osteotomy on tibial rotation. Int Orthop 40(9):1849–1854

    Article  PubMed  Google Scholar 

  17. Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ (2017) Analysis of outcomes for high tibial osteotomies performed with cartilage restoration techniques. Arthroscopy 33(2):486–492

  18. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138

    Article  PubMed  Google Scholar 

  19. Madry H, Goebel L, Hoffmann A, Duck K, Gerich T, Seil R, Tschernig T, Pape D (2016) Surgical anatomy of medial open-wedge high tibial osteotomy: crucial steps and pitfalls. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4181-3

    Google Scholar 

  20. Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646

    Article  PubMed  Google Scholar 

  21. Muller M, Strecker W (2008) Arthroscopy prior to osteotomy around the knee? Arch Orthop Trauma Surg 128(11):1217–1221

    Article  CAS  PubMed  Google Scholar 

  22. Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3‑year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26(12):1607–1616

    Article  PubMed  Google Scholar 

  23. Noyes FR, Barber-Westin SD, Hewett TE (2000) High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med 28(3):282–296

    Article  CAS  PubMed  Google Scholar 

  24. Noyes FR, Mayfield W, Barber-Westin SD, Albright JC, Heckmann TP (2006) Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med 34(8):1262–1273

    Article  PubMed  Google Scholar 

  25. Pape D, Adam F, Seil R, Georg T, Kohn D (2005) Fixation stability following high tibial osteotomy: a radiostereometric analysis. J Knee Surg 18(2):108–115

    Article  PubMed  Google Scholar 

  26. Pape D, Kohn D, van Giffen N, Hoffmann A, Seil R, Lorbach O (2013) Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):82–89

    Article  CAS  PubMed  Google Scholar 

  27. Reising K, Strohm PC, Hauschild O, Schmal H, Khattab M, Sudkamp NP, Niemeyer P (2013) Computer-assisted navigation for the intraoperative assessment of lower limb alignment in high tibial osteotomy can avoid outliers compared with the conventional technique. Knee Surg Sports Traumatol Arthrosc 21(1):181–188

    Article  PubMed  Google Scholar 

  28. Savarese E, Bisicchia S, Romeo R, Amendola A (2011) Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner. J Orthop Traumatol 12(1):1–17

    Article  PubMed  Google Scholar 

  29. Schroter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D (2011) High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy 27(5):644–652

    Article  PubMed  Google Scholar 

  30. Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy: closing – versus opening-wedge methods. J Bone Joint Surg Br 92(9):1245–1252

    Article  CAS  PubMed  Google Scholar 

  31. Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653

    Article  PubMed  Google Scholar 

  32. Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22(3):218–225

    Article  PubMed  Google Scholar 

  33. Wilson NA, Scherl SA, Cramer KE (2007) Complications of high tibial osteotomy with external fixation in adolescent Blount’s disease. Orthopedics 30(10):848–852

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    P. Niemeyer

  2. OCM Klinik GmbH, München, Deutschland

    P. Niemeyer, A. Stöhr, M. Köhne &  A. Hochrein

Authors
  1. P. Niemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Stöhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Köhne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Hochrein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Niemeyer.

Ethics declarations

Interessenkonflikt

P. Niemeyer, A. Stöhr, M. Köhne und A. Hochrein geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Editor

A.B. Imhoff, München

Zeichner

J. Kühn, Mannheim

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niemeyer, P., Stöhr, A., Köhne, M. et al. Valgisierende Tibiakopfosteotomie in öffnender Technik. Oper Orthop Traumatol 29, 294–305 (2017). https://doi.org/10.1007/s00064-017-0509-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-017-0509-5

Schlüsselwörter

Keywords

Search

Navigation