J Korean Orthop Assoc.  2012 Apr;47(2):104-110. 10.4055/jkoa.2012.47.2.104.

Comparison of Closing-Wedge and Opening-Wedge High Tibial Osteotomies

• Cho SH
• Hwang SC
• Sohn KM
• Kim HK

• KMID: 2185385
• DOI: http://doi.org/10.4055/jkoa.2012.47.2.104

Abstract

PURPOSE
The aim of this study is to compare the clinical results and radiologic changes of closing-wedge high tibial osteotomy (CW HTO) and opening-wedge high tibial osteotomy (OW HTO).
MATERIALS AND METHODS
Seventy five knees were treated with a CW HTO and 41 with an OW HTO. For each patient the hip-knee-ankle (H-K-A) axis was evaluated and the degree of the medial compartmental arthrosis was measured by Ahlback-type radiological classification. The function of the knee was evaluated by the Tegner activity score, the Lysholm knee scoring scale and the Western Ontario and McMaster University index. Lateral radiographs were taken to assess the patellar height and the posterior tibial inclination.
RESULTS
In both groups significant improvement of the visual analogue scale and range of motion was achieved. The frontal plane H-K-A axis was corrected significantly from varus to the range of physiological valgus and the arthrosis of the medial compartment of the knee progressed gradually. The body mass index was significantly influential to the progression of arthrosis. The functions of the knee were improved significantly in all cases. In the closing-wedge group, the patella height was increased at the postoperative period, while it was decreased in the opening-wedge group. There was a tendency of a decrease of the tibial inclination in the CW HTO group and a statistically significant increase of the tibial inclination in the OW HTO group. Recurrence of varus occurred in sixteen cases.
CONCLUSION
In both groups, improvement of the function of the knee was achieved, but there was no statistical difference. However, the opposite result was found in the patella height and the tibial inclination.

Keyword

high tibial osteotomy; closing-wedge high tibial osteotomy; opening-wedge high tibial osteotomy; compare

MeSH Terms

Axis, Cervical Vertebra
Body Mass Index
Humans
Knee
Ontario
Osteotomy
Patella
Postoperative Period
Range of Motion, Articular
Recurrence

Figure

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  Figure 1 Visual analogue scale score. Preop, preoperative; Postop, postoperative; CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy.

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  Figure 2 Preoperative and postoperative standing radiographs showing satisfactory correction of the varus deformity and the fixation of the osteotomy with 90 degree angled blade plate designed by Se-Hyun Cho. The final standing x-ray shows maintenance of the correction after removal of the hardware.

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  Figure 3 Preoperative varus gonarthrosis is well corrected by open wedge high tibial osteotomy fixed with anatomical plate.

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  Figure 4 Correction in the frontal plane hip-knee-ankle axis. CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative; f/u, follow-up.

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  Figure 5 Radiologic changes evaluated by Ahlbäck classification. CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative.

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  Figure 6 Tegner activity score. Preop, preoperative; Postop, postoperative; CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy.

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  Figure 7 Lysholm knee scoring scale. Preop, preoperative; Postop, postoperative; CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy.

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  Figure 8 Patella height. CWO, closing-wedge osteotomy; ISI, Insall-Salvati Index; BPI, Blackburne Peel Index; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative; f/u, follow-up.

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  Figure 9 Posterior slope. CWO, closing-wedge osteotomy; OWO, opening-wedge osteotomy; Preop, preoperative; Postop, postoperative; f/u, follow-up.

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