The purpose of this study was to perform a retrospective clinical and radiographic evaluation after opening-wedge high tibial osteotomy (HTO) using a short spacer plate (Aescula; B. Braun Korea, Seoul, South Korea) and rigid long plate (TomoFix plate; Mathys, Bettlach, Switzerland) at follow-up 2 years postoperatively.
We performed 94 opening-wedge HTOs with the Aescula plate (group I) and 92 HTOs with the TomoFix plate (group II). Patients underwent clinical and radiographic evaluations preoperatively and at 2 years postoperatively. Clinical evaluations were performed with Knee Society scores. Radiographic analysis included the mechanical tibiofemoral angle (mTFA) and the slope of the tibia angle with preoperative and postoperative full weight–bearing anteroposterior whole-leg views, as well as anteroposterior, lateral, and Merchant views of the knee. We measured the mTFA. In addition, we evaluated the complications in each group. The follow-up period was 2 years.
At follow-up 2 years postoperatively, we observed an overall complication rate of 38% in group I and 26% in group II (P = .083). We found plate-related complication rates of 20% in group I and 9% in group II (P = .039). Plate-related complications included loss of correction, fracture of the tibial plateau, screw failure, malunion, and fracture of the lateral cortical bone. The mean mTFA was −6.0° ± 3.2° in group I and −4.6° ± 2.8° in group II preoperatively (P = .262). The mean mTFA was 1.0° ± 3.1° in group I and 1.5° ± 2.3° in group II at the latest follow-up (P = .034). In group I, the mean Knee Society knee score and function score were 60.0 ± 12.9 and 57.9 ± 26.8, respectively, preoperatively. They improved to 92.1 ± 8.1 and 89.0 ± 15.1, respectively, at follow-up (P = .001 and P = .001, respectively). In group II, the mean Knee Society knee score and function score were 57.5 ± 14.8 and 57.4 ± 22.1, respectively, preoperatively. They improved to 95.5 ± 5.4 and 95.0 ± 7.6, respectively, at follow-up (P = .001 and P = .001, respectively). In addition, the mean postoperative knee score and function score in group II were higher than those in group I (P = .001 and P = .001, respectively).
We have shown a high plate-related complication rate and a significant loss of correction during a short-term follow-up period (2 years) after opening-wedge HTO using the new short spacer HTO plate compared with the rigid long plate.
Level of Evidence
Level IV, therapeutic case series.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients.Arch Orthop Trauma Surg. 2005; 125: 638-643
- Fifteen to twenty-eight years' follow-up results of high tibial valgus osteotomy for osteoarthritic knee.Knee. 2004; 11: 439-444
- The oblique high tibial osteotomy technique without bone removal and with rigid blade plate fixation for the treatment of medial osteoarthritis of the varus knee: Medium and long-term results.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 940-947
- High tibial osteotomy with anterior advancement of distal fragment for medial and patellofemoral compartmental osteoarthritis of the knee.Knee. 2002; 9: 127-132
- Proximal tibial osteotomy. A critical long-term study of eighty-seven cases.J Bone Joint Surg Am. 1993; 75: 196-201
- Long term results of 260 tibial osteotomies for frontal deviations of the knee.Rev Chir Orthop Reparatrice Appar Mot. 1972; 58 (in French): 335-339
- Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.J Bone Joint Surg Am. 1987; 69: 332-354
- Improvements in surgical technique of valgus high tibial osteotomy.Knee Surg Sports Traumatol Arthrosc. 2003; 11: 132-138
- TomoFix: A new LCP-concept for open wedge osteotomy of the medial proximal tibia—Early results in 92 cases.Injury. 2003; 34: 55-62
- Results of high tibial osteotomy: Review of the literature.Int Orthop. 2010; 34: 155-160
- 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. 2010; 26: 1607-1616
- The short-term follow-up results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft: The minimum 1-year follow-up results.Clin Orthop Surg. 2010; 2: 47-54
- Primary stability of four different implants for opening wedge high tibial osteotomy.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 291-300
- Open wedge high tibial osteotomy: Biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate.Clin Biomech. 2004; 19: 944-950
- Biomechanical evaluation of a proximal tibial opening wedge osteotomy plate.Am J Knee Surg. 1999; 12: 148-153
- Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: A biomechanical cadaver study.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 204-211
- The stability of three commercially available implants used in medial opening wedge high tibial osteotomy.J Knee Surg. 2006; 19: 95-98
- Primary stability of various implants in tibial opening wedge osteotomy: A biomechanical study.J Orthop Sci. 2002; 7: 683-687
- The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints.Orthop Clin North Am. 1979; 10: 585-608
- Proximal tibial osteotomy. A new fixation device.Clin Orthop Relat Res. 1989; : 250-259
- Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference.BMC Health Serv Res. 2002; 2: 8
- Open wedge high tibial osteotomy with Aescula(R) plate.J Korean Orthop Assoc. 2009; 44: 336-343
- Medial opening wedge high tibial osteotomy with early full weight bearing.Arthroscopy. 2009; 25: 46-53
- Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: A new classification of lateral hinge fracture.Arthroscopy. 2012; 28: 85-94
- Stability of medial opening wedge high tibial osteotomy: A failure analysis.Int Orthop. 2010; 34: 217-223
- Complications in high tibial (medial opening wedge) osteotomy.Arch Orthop Trauma Surg. 2004; 124: 649-653
- High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute.Arthroscopy. 2011; 27: 644-652
- High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 948-954
- Early results of medial opening wedge osteotomy in varus gonarthrosis.Acta Orthop Traumatol Turc. 2006; 40 (in Turkish): 193-198
- Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee.Arthroscopy. 2008; 24: 796-804
- Valgus tibial osteotomy: Avoiding the pitfalls.Clin Orthop Relat Res. 1981; : 137-143
- High tibial osteotomy with fixation by a blade plate for medial compartment osteoarthritis of the knee.Orthop Clin North Am. 1989; 20: 227-243
Published online: April 29, 2013
Accepted: February 18, 2013
Received: June 21, 2012
The authors report that they have no conflicts of interest in the authorship and publication of this article.
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.