Koshino, Tomihisa MD, PhD
This paper describes the detailed surgical techniques of opening hydroxyapatite (HA) wedge high tibial valgus osteotomy for knees with medial compartmental osteoarthritis. The clinical results are compared with those of conventional closing wedge osteotomy. As special features of this osteotomy, 2 wedges (hooked and hookless) of the same height are inserted into the opened transverse osteotomy site above the tibial tuberosity, from the anteromedial portion in a posterolateral direction, together with bone grafts, and the fragments are fixed with 2 plates. The angle of correction can be adjusted by the direction of wedge insertion. In our previous report, 5 osteotomy was performed in 21 osteoarthritic knees of 18 patients (15 women and 3 men), with a mean age of 66.6 +/- 5.5 years (range 55 to 79) with mean follow-up of 78.6 +/- 22.2 months (range 38 to 114). Knee and function scores of the American Knee Society were 60.2 +/- 5.3 and 48.1 +/- 10.4 points, respectively, before osteotomy, which significantly increased to 94.8 +/- 7.3 and 93.1 +/- 9.8 points at follow-up. Compared with conventional closing wedge high tibial osteotomy, opening wedge osteotomy is advantageous in being a simpler procedure with only one transverse bone cut and in causing no loss of limb alignment. The correction of deformity, however, is limited to a maximum of 25 degrees and ideally does not exceed 15 degrees.
Techniques in Knee Surgery. 3(4):206-214, December 2004.