Summary

Simultaneous bilateral high tibial osteotomy is a useful method not only for bilateral knee osteoarthritis treatment but also for medical economics.

Abstract

Introduction

The number of opening high tibial osteotomy cases is increasing. The success of the angle stable locking plate and bone substitute materials for the opening gap have much affected to this increase. Good results with early weight bearing were reported, but little about simultaneous bilateral osteotomy. We performed clinical, radiographic and medical economic evaluation of patients who had undergone simultaneous bilateral high tibial osteotomy with immediate full weight bearing exercise. Opening wedge osteotomy was performed by use of angle stable locking plate and bone substitute materials.

Methods

Simultaneous opening wedge high tibial osteotomy was performed in 42 knees in 21 patients with a mean age of 66.9 years (range, 56 to 86 years) at the time of operation. The diagnosis was primary osteoarthritis in all patients. All the patients were performed arthroscopic treatment at the same time of osteotomy. A weight bearing exercise was started in the next morning after the operation without weight bearing restriction. Full weight bearing was performed as soon as possible. All the patients were discharged after stable stair exercise with T-cane.

Results

The mean follow-up period was 22.6months (range, 9 to 34 months). The mean operation time was 181 minutes in comparison to 116 minutes in unilateral cases. The mean days of full weight bearing exercise after surgery was 2.0 days (range, 1 to 5 days). The mean days of hospital stay was 29.5 days in comparison to 30.0 days in unilateral cases. The Knee Society Score was improved from 58.7 points before surgery to 89.7 points at the last follow up. There was no implant failure and nonunion in our cases. The total hospital cost of this surgery was 25% less than that of twice unilateral surgery in bilateral knee osteoarthritis cases. Patients can save their hospital days about one month in comparison to twice unilateral surgery.

Conclusions

A good clinical results were obtained in our case series of an immediate full weight bearing after simultaneous bilateral high tibial osteotomy. In addition, this method might be effective from the view point of medical economics and socioeconomics.