MID TERM OUTCOME OF OPEN WEDGE HIGH TIBIAL OSTEOTOMY AT ORTHOPAEDICS DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

Abstract

Introduction: High tibial osteotomy (HTO) is a common surgical technique for isolated medial compartment osteoarthritis of tibio-femoral component of knee, indicated in young and active patients with varus deformity. It can be performed by lateral closed wedge osteotomy, medial open wedge osteotomy and dome osteotomy. Purpose of this study was to evaluate the (1) Incidence and severity of complications after medial open wedge osteotomy, (2) functional outcome, (3) survival rate of HTO, (4) incidence of revision to TKR. Materials And Methods: We have evaluated 32 knees in 27 patients operated during last 3 years (August 2016 to July 2019) who have undergone Medial open wedge HTO for Unicompartmental (medial) OA of knee. The indications for surgery were medial compartment osteoarthritis with varus deformity of knee, young and active patients with age < 55yrs, progressive symptoms unresponsive to conservative treatment for at least 6 months, >90˚ of flexion, flexion contracture <10˚, intact cruciates and collaterals. Post-operatively, patients were followed up every month till bony union, thereafter every 3 months for 1yr post-surgery, at final follow-up and were evaluated for the complications and the functional outcome using HSS knee score. Results: The mean duration of bony union was 12 weeks (10-16). All the pre-operative range of movements was retained post-operatively. HSS knee score has increased significantly following medial open wedge HTO. 5 year-survival rate was 100% and 10 year-survival rate was 87.5%. Four patients were revised to total knee replacement (12.5%). In our study, overall complication rate was 10.93%. Conclusion: Success of arthroplasty in recent decades has degraded HTO lately, but HTO is still a viable option for young and active patients with medial compartment osteoarthritis of knee with varus deformity, with flexion >90˚, with flexion contracture < 10˚. It is less expensive and no changes in lifestyle are required which is very useful in Indian perspective. It retains all the pre-operative movements and helps in delaying total knee arthroplasty.