Comparative analysis of the outcomes of high tibial osteotomy performed with different techniques

Introduction Opening- and closing wedge osteotomies are the two most commonly used variants of high tibial osteotomy in medial gonarthrosis associated with varus deformity.

Purpose Based on a retrospective analysis of the results of surgical treatment of patients with medial gonarthrosis associated with varus deformity of the proximal tibia, to evaluate functional and radiological outcomes of high tibial osteotomy performed with two different surgical techniques.

Material and methods The study included 37 patients (26 men and 11 women) aged 20 to 54 years (42.84 ± 9.1) with meadial gonarthrosis associated with varus deformity in the frontal plane. The first group included 23 patients with 25 operated limbs who underwent open wedge osteotomy (OWO), the second group included 14 patients who underwent closed wedge osteotomy (CWO).

Results Comparison of MPTA, LDTA, aPPTA and MAD in both groups after surgery did not show a statistically significant difference (p > 0.05), but in the closing wedge group, the recorded values had an extremely wide range. The results on the Lisholm-Tegner scale after surgery compared between the two groups showed a statistically significant difference (p = 0.05), this parameter showed that the opening-wedge osteotomy was more effective.

Discussion Opening wedge osteotomy is a more predictable surgical procedure compared to closing wedge osteotomy. In opening wedge osteotomy, there are significantly fewer cases with excessive or insufficient correction of reference angles and lines than after closing wedge osteotomy.

Conclusion Absence of specific surgical complications in the studied patients demonstrates the safety of  both surgical techniques. The study showed an extremely wide range of MPTA and LDTA values in the closed wedge osteotomy group, which were beyond the preoperative planning. The CWO group had the highest number of patients who underwent hypercorrection of the mechanical limb axis, which was beyond the reference values. It is possible to use a small allograft or not to use it at all in OWO, which makes it a more manageable technology for correcting limb bone deformity.

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