Combined wedge high tibial osteotomy can achieve and maintain an accurate over-correction of great varus knee deformity
Closing and opening wedge high tibial osteotomy (HTO) are established treatment for medial compartment osteoarthritis of knee with varus mal-alignment. Nevertheless, there is a limit for amount of angular correction achieved by both techniques.
Combined wedge HTO can achieve accurate over-correction of large varus deformity with few anatomical changes of proximal tibia after 1 year of surgery.
Fifty four knees in patients with medial compartment osteoarthritis and big varus mal-alignment (15º) underwent combined wedge HTO with 20º angular correction. Primary outcome measure / endpoint was over-correction of 5º valgus over 1 year after surgery as assessed by hip knee ankle angle (HKA). Secondary objectives were radiological measures of tibial slope (TS), Insall Salvati ratio (IS) and Blackburn Peel ratio (BP) were assessed pre-operatively and 1 year after surgery. Clinical outcome measures; visual analogue scale and KOOS score were measured six weeks, six months and 1 year post-operatively.
HKA changed from 5.3º varus to 15.2º valgus (p = 0.000). No statistically significant difference was found in TS (p= 0.9), IS (p=0.75) and BP (p=0.59). Only 3.7% showed patella baja (BP <0.54). 94.7 % of patients were clinically satisfied after 1 year.
Combined wedge HTO technique can achieve and maintain accurate correction of large varus deformity of the knee. This relatively new technique can replace external fixators in such a difficult situation.
Medial compartment, Osteoarthritis, Varus mal-alignment, Combined wedge, High tibial osteotomy