Midterm follow-up of closing wedge high tibial osteotomy with upper tibiofibular joint capsulotomy
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UP-TO DATE REVIEW AND CASE REPORT • KNEE - OSTEOTOMY
Midterm follow‑up of closing wedge high tibial osteotomy with upper tibiofibular joint capsulotomy Hosein Ahmadzadeh Chabok1 Received: 20 December 2018 / Accepted: 25 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
Abstract Closing wedge high tibial osteotomy is a popular surgery for correcting varus knee in symptomatic patients. One of the major drawbacks of this method is complications related to fibular osteotomy. This study describes pearl and pitfalls of closing wedge high tibial osteotomy with upper tibiofibular joint capsulotomy, avoiding fibular osteotomy and proposes that it has less complications and better results. Closing wedge high tibial osteotomy with upper tibiofibular joint capsulotomy was carried on 34 knees (19 patients) between September 2011 and June 2015 (thirteen males and six females). Operated men were between 19 and 38 years with mean 21 years. Operated women were between 23 years and 51 years. Considering that only one woman was 23 years old and the other four were between 45 and 51, better results and fewer complications were obtained in younger individuals with less body mass index and milder deformities. As a conclusion, when selecting patients, it is vital to stick to inclusion criteria. When in two or more factors, the patient is close to upper limits of inclusion criteria, unsatisfactory outcomes might be expected. Keywords Closing wedge · High tibial osteotomy · Fibular osteotomy · Varus deformity · Peroneal nerve palsy
Introduction High tibial osteotomy is considered to be one of the most accepted procedures in correcting varus deformity of the knee, off-loading of the medial compartment of the knee and decelerating degenerative joint process [1–4]. It is basically supposed that any major deviation from normal weight bearing axis, leading to uneven weight force distribution, produces pain and predisposes the knee joint to degenerative changes [3, 4]. So high tibial osteotomy is considered to be an acceptable procedure to alleviate pain in a painful varus knee, postpone degenerating changes in a progressive varus deformity and decelerate destruction of a medial knee joint arthrosis [3–5]. Proper patient selection, preoperative planning and suitable surgical technique are keys to desirable outcome. The ideal candidate for high tibial osteotomy is a youngto-middle-age patient with a painful varus knee and a documented overloaded medial compartment on a plain * Hosein Ahmadzadeh Chabok [email protected] 1
Shams Hospital, Bahar 54, Bahar Avenue, Mashhad, Khorasan Razavi, Iran
radiography or a middle-aged patient with mild-to-moderate uni-compartment medial degenerating joint disease [1–4]. There is general consensus on poor prognostic factors and contraindications in high tibial osteotomy. Knee ROM 15°, other compartments involvement, rheumatoid arthritis, more than 20° of correction required, more than 10 mm of lateral subluxation, sever degenerative changes (Ahlback grade III and more) and
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