Outcomes of Open Wedge High Tibial Osteotomy with Puddu Plate, with a Minimum Follow-up of 5 Years
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Published:
Oct 17, 2024
Keywords:
Tibial valgus osteotomy, tibial opening wedge osteotomy, Puddu plate, genu varum, medial compartment osteoarthritis
Main Article Content
Abstract
Objectives: To determine the survival rate of high tibial osteotomy for medial knee osteoarthritis and describe functional outcomes and the satisfaction rate.
Materials and Methods: Observational, analytical study with retrospective data collection. A total of 51patients were operated on between 2011 and 2017. Variables studied included age, sex, preoperative BMI, VAS for pre- and postoperative pain, WOMAC and Lysholm functional scores, SF-12 quality of life scores, satisfaction with the procedure, and conversion to arthroplasty.
Results: The average age at the time of surgery was 55.7 years, with an average BMI of 29.7. Follow-up ranged from 5 to 11 years. We observed a statistically significant decrease in VAS scores from 7.96 ± 2.27 to 3.04 ± 2.73. The average survival time of the osteotomy was 10.53 years (95% CI, 9.6 -11.4). Patient satisfaction was positive in 76.5% of cases, showing a statistically significant difference and better outcomes in the evaluated scores. The conversion rate to total knee arthroplasty (TKA) was 19.6%. There was no statistically significant relationship between conversion to TKA and the initial age, BMI, or VAS score.
Conclusions: Open wedge high tibial osteotomy showed excellent outcomes with a minimum follow-up of 5 years, with a survival rate and conversion to arthroplasty comparable to international literature. There was a statistically significant reduction in pain according to VAS scores, and younger patients reported higher satisfaction with the procedure.
Materials and Methods: Observational, analytical study with retrospective data collection. A total of 51patients were operated on between 2011 and 2017. Variables studied included age, sex, preoperative BMI, VAS for pre- and postoperative pain, WOMAC and Lysholm functional scores, SF-12 quality of life scores, satisfaction with the procedure, and conversion to arthroplasty.
Results: The average age at the time of surgery was 55.7 years, with an average BMI of 29.7. Follow-up ranged from 5 to 11 years. We observed a statistically significant decrease in VAS scores from 7.96 ± 2.27 to 3.04 ± 2.73. The average survival time of the osteotomy was 10.53 years (95% CI, 9.6 -11.4). Patient satisfaction was positive in 76.5% of cases, showing a statistically significant difference and better outcomes in the evaluated scores. The conversion rate to total knee arthroplasty (TKA) was 19.6%. There was no statistically significant relationship between conversion to TKA and the initial age, BMI, or VAS score.
Conclusions: Open wedge high tibial osteotomy showed excellent outcomes with a minimum follow-up of 5 years, with a survival rate and conversion to arthroplasty comparable to international literature. There was a statistically significant reduction in pain according to VAS scores, and younger patients reported higher satisfaction with the procedure.
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How to Cite
Porcelli, D., Kenny, J., Del Castillo, J. M., Francescoli, L., & Rey, R. (2024). Outcomes of Open Wedge High Tibial Osteotomy with Puddu Plate, with a Minimum Follow-up of 5 Years. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 488-497. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1475
Section
Clinical Research
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References
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6. Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sport Traumatol Arthrosc 2017;26(11):3199-205. https://doi.org/10.1007/s00167-017-4816-z
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8. Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 2004;19:944-50.
https://doi.org/10.1016/j.clinbiomech.2004.06.007
9. Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, et al. The effect of patient age at
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10. Kim JH, Kim HJ, Lee DH. Survival of opening versus closing wedge high tibial osteotomy: A meta-Analysis. Sci
Rep 2017;7(1):1-7. https://doi.org/10.1038/s41598-017-07856-8
11. Darees M, Putman S, Brosset T, Roumazeille T, Pasquier G, Migaud H. Opening-wedge high tibial osteotomy
performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise
follow-up note of 48 cases at 10 years’ follow-up. Orthop Traumatol Surg Res 2018;104(4):477-80.
https://doi.org/10.1016/j.otsr.2017.12.021
12. Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sport Traumatol Arthrosc 2006;14(10):948-54. https://doi.org/10.1007/s00167-006-0074-1
13. Schallberger A, Jacobi M. High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years. Knee Surg Sport Traumatol Arthrosc 2011;19(1):122-7.
https://doi.org/10.1007/s00167-010-1256-4
14. Han SB, Lee JH, Kim SG, Cui CG, Suh DW, Lee SY, et al. Patient-reported outcomes correlate with functional
scores after opening-wedge high tibial osteotomy: a clinical study. Int Orthop 2018;42(5):1067-74.
https://doi.org/10.1007/s00264-017-3614-z
15. Ollivier B, Berger P, Depuydt C, Vandenneucker H. Good long-term survival and patient-reported outcomes
after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sport Traumatol Arthrosc 2021;29(11):3569-84. https://doi.org/10.1007/s00167-020-06262-4
16. Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight
patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sport Traumatol
Arthrosc 2011;19(3):333-9. https://doi.org/10.1007/s00167-010-1335-6
17. He A, Wang Y, Chen Y, Zhou Y, Zhang H, Mao Y, et al. High-risk factors for subjective discomfort due to lower limb discrepancy after medial open wedge high tibial osteotomy. J Orthop Surg Res 2021;16(1):438.
https://doi.org/10.1186%2Fs13018-021-02542-y
18. Capella M, Gennari E, Dolfin M, Saccia F. Indications and results of high tibial osteotomy. Ann Joint 2017;2(6):33. https://doi.org/10.21037/AOJ.2017.06.06
19. Saier T, Minzlaff P, Feucht MJ, Lämmle L, Burghoff M, Ihle C, et al. Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sport Traumatol Arthrosc 2017;25(3):934-42. https://doi.org/10.1007/s00167-015-3938-4
20. van Meer BL, Meuffels DE, Reijman M. A comparison of the standardized rating forms for evaluation of
anterior cruciate ligament injured or reconstructed patients. En: Prodromos C. The anterior cruciate ligament:
Reconstruction and Basic Science. 2nd ed. Elsevier; 2018. 484-489.e2. https://doi.org/10.1016/B978-0-323-38962-4.00120-X
21. Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N, et al. Evaluation of the “minimal clinically important
difference” (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sport
Traumatol Arthrosc 2020;29(3):820-6. https://doi.org/10.1007/s00167-020-06026-0
2. He M, Zhong X, Li Z, Shen K, Zeng W. Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review. Syst Rev 2021;10(1):1-10. https://doi.org/10.1186/s13643-021-01601-z
3. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High tibial osteotomy: A systematic review and current
concept. Arch Bone Jt Surg 2016;4(3):204-12. PMID: 27517063
4. Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR. Adverse event rates and classifications in
medial opening wedge high tibial osteotomy. Am J Sports Med 2014;42(5):1118-26. https://doi.org/10.1177/0363546514525929
5. Han S, In Y, Oh KJ, Song KY, Yun ST, Jang K. Complications associated with medial opening-wedge high tibial
osteotomy using a locking plate: A multi-center study. J Arthroplasty 2019;34(3):439-45. https://doi.org/10.1016/j.arth.2018.11.009
6. Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sport Traumatol Arthrosc 2017;26(11):3199-205. https://doi.org/10.1007/s00167-017-4816-z
7. Golovakha ML, Orljanski W, Benedetto KP, Panchenko S, Büchler P, Henle P, et al. Comparison of theoretical
fixation stability of three devices employed in medial opening wedge high tibial osteotomy: A finite element
analysis. BMC Musculoskelet Disord 2014;15(1):1-12. https://doi.org/10.1186/1471-2474-15-230
8. Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 2004;19:944-50.
https://doi.org/10.1016/j.clinbiomech.2004.06.007
9. Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, et al. The effect of patient age at
intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 2017;389(10077):1424-30. https://doi.org/10.1016/S0140-6736(17)30059-4
10. Kim JH, Kim HJ, Lee DH. Survival of opening versus closing wedge high tibial osteotomy: A meta-Analysis. Sci
Rep 2017;7(1):1-7. https://doi.org/10.1038/s41598-017-07856-8
11. Darees M, Putman S, Brosset T, Roumazeille T, Pasquier G, Migaud H. Opening-wedge high tibial osteotomy
performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise
follow-up note of 48 cases at 10 years’ follow-up. Orthop Traumatol Surg Res 2018;104(4):477-80.
https://doi.org/10.1016/j.otsr.2017.12.021
12. Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sport Traumatol Arthrosc 2006;14(10):948-54. https://doi.org/10.1007/s00167-006-0074-1
13. Schallberger A, Jacobi M. High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years. Knee Surg Sport Traumatol Arthrosc 2011;19(1):122-7.
https://doi.org/10.1007/s00167-010-1256-4
14. Han SB, Lee JH, Kim SG, Cui CG, Suh DW, Lee SY, et al. Patient-reported outcomes correlate with functional
scores after opening-wedge high tibial osteotomy: a clinical study. Int Orthop 2018;42(5):1067-74.
https://doi.org/10.1007/s00264-017-3614-z
15. Ollivier B, Berger P, Depuydt C, Vandenneucker H. Good long-term survival and patient-reported outcomes
after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sport Traumatol Arthrosc 2021;29(11):3569-84. https://doi.org/10.1007/s00167-020-06262-4
16. Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight
patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sport Traumatol
Arthrosc 2011;19(3):333-9. https://doi.org/10.1007/s00167-010-1335-6
17. He A, Wang Y, Chen Y, Zhou Y, Zhang H, Mao Y, et al. High-risk factors for subjective discomfort due to lower limb discrepancy after medial open wedge high tibial osteotomy. J Orthop Surg Res 2021;16(1):438.
https://doi.org/10.1186%2Fs13018-021-02542-y
18. Capella M, Gennari E, Dolfin M, Saccia F. Indications and results of high tibial osteotomy. Ann Joint 2017;2(6):33. https://doi.org/10.21037/AOJ.2017.06.06
19. Saier T, Minzlaff P, Feucht MJ, Lämmle L, Burghoff M, Ihle C, et al. Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sport Traumatol Arthrosc 2017;25(3):934-42. https://doi.org/10.1007/s00167-015-3938-4
20. van Meer BL, Meuffels DE, Reijman M. A comparison of the standardized rating forms for evaluation of
anterior cruciate ligament injured or reconstructed patients. En: Prodromos C. The anterior cruciate ligament:
Reconstruction and Basic Science. 2nd ed. Elsevier; 2018. 484-489.e2. https://doi.org/10.1016/B978-0-323-38962-4.00120-X
21. Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N, et al. Evaluation of the “minimal clinically important
difference” (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sport
Traumatol Arthrosc 2020;29(3):820-6. https://doi.org/10.1007/s00167-020-06026-0