Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis.

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Abstract

[Indexed for MEDLINE] 2. Oper Orthop Traumatol. 2017 Aug;29(4):294-305. doi: 10.1007/s00064-017-0509-5. Epub 2017 Jun 22. [Medial opening wedge high tibial osteotomy]. [Article in German] Niemeyer P(1)(2), Stöhr A(3), Köhne M(3), Hochrein A(3). Author information: (1)Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland. phniemeyer@gmail.com. (2)OCM Klinik GmbH, München, Deutschland. phniemeyer@gmail.com. (3)OCM Klinik GmbH, München, Deutschland. OBJECTIVE: Reduction of the load to the medial compartment in patients with medial knee osteoarthritis and varus malalignment. Unloading of the posterolateral complex in varus deformity with complex ligamentous laxity. INDICATIONS: Medial knee osteoarthritis and varus malalignment with largely intact lateral and patellofemoral joint aspect. Complex ligament insufficiency combined with varus deformity. CONTRAINDICATIONS: Substantially impaired range of motion. SURGICAL TECHNIQUE: Medial skin incision on the proximal lower leg. Preparation of the pes anserinus. Marking of the osteotomy from the deepest point of the medial metaphysis laterally ascending. Biplane osteotomy, carefully protecting the posterior neurovascular structures, with ventral completion proximal or distal to the tibial tuberosity, depending on concomitant pathologies. Angular-stable plate fixation. POSTOPERATIVE MANAGEMENT: In general, early weight bearing is possible when angular-stable plate fixation is used. Often concomitant pathologies such as accompanying cartilage regenerative therapy necessitate longer unloading. Range of motion does not need to be restricted following stand-alone osteotomy. Orthoses are recommended regularly. RESULTS: Under the correct indication, the medial opening wedge high tibial osteotomy (OW-HTO) technique can achieve good results with high patient satisfaction, despite a relatively high statistical complication rate, provided that a standardized surgical technique is used. There is a tendency for a poorer outcome in patients with a body mass index above 30 and higher stages of osteoarthritis. DOI: 10.1007/s00064-017-0509-5