A Comparison of the results and prognosis of genovarum correction with open wedge osteotomy and open wedge osteotomy with sagital plane cutting methods in the treatment of patients with varus knee deformity

  • Morteza Saeb Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.
  • Seyyd saeed Khabiri Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.
  • Monireh Yaghoubi Mail Faculty of medicine, Kermanshah University of Medical science
  • Ali Mousapour Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.
  • Keykhosro Mardanpour Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.
  • Roya Safari-Faramani Department of Epidemiology School of Public Health Kermanshah University of Medical Sciences
  • Alireza Shafiee Kermanshah University of medical sciences,Taleqani Hospital.
  • Adel hojabrian Kermanshah University of medical sciences,Taleqani Hospital.
  • Sepehr Rahimipour Kermanshah University of medical sciences,Taleqani Hospital.
Keywords:
Open Wedge High Tibial Osteotomy, genovarum, tibial tubercle osteotomy

Abstract

Background: Open wedge high tibial osteotomy (OWHTO) is commonly utilized to correct genu varum. To decrease various complications of OWHTO, some modifications are needed.

 

Methods: In a parallel randomized controlled clinical trial, 42 patients were divided into two groups: conventional OWHTO (control group) and OWHTO with the cut in the sagittal plane or distal tubercle osteotomy (OWHTO/DTO) (intervention group). Evaluation of the following items was conducted pre- and post-operatively: Knee Society Score (KSS) questionnaire, incidence of postoperative complications, patellar height by Blackburne-Peel (BP) ratio and Insall-Salvati Index (ISI), posterior tibial slope (PTS), tibiofemoral angle (TFA), Q-angle, medial proximal tibial angle (MPTA), three joint alignment radiography, and union radiological parameters.

 

Results: The differences between preoperative and postoperative variables including the KSS, PTS, TFA, BP Index (BPI), ISI, MPTA, and Q-angle within the intervention and control groups were not statistically significant. In four cases (3 in the control group and 1 in the intervention group), the delayed union was observed but the complete union was achieved after a mean of 23 weeks. No nonunion was observed.

 

Conclusion: Our results showed equal effectiveness for OWHTO/DTO compared with the conventional OWHTO.

Author Biographies

Morteza Saeb, Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.

Associate Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Seyyd saeed Khabiri, Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.

Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Monireh Yaghoubi, Faculty of medicine, Kermanshah University of Medical science

Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Ali Mousapour, Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.

Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Keykhosro Mardanpour, Faculty of medicine, Kermanshah University of medical sciences,Taleqani Hospital.
  • Associate Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Roya Safari-Faramani, Department of Epidemiology School of Public Health Kermanshah University of Medical Sciences

Assistant Professor, Department of Epidemiology, Research Center for Environmental Determinants of Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran

Alireza Shafiee, Kermanshah University of medical sciences,Taleqani Hospital.

Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Adel hojabrian, Kermanshah University of medical sciences,Taleqani Hospital.

Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Sepehr Rahimipour, Kermanshah University of medical sciences,Taleqani Hospital.

Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

References

1. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: Patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br. 2008;90(12):1548-57. doi: 10.1302/0301-620X.90B12.21198. [PubMed: 19043123].

2. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee: Report on the association of sports traumatology, arthroscopy, orthopaedic surgery, rehabilitation (ASTAOR) Moscow international osteotomy congress 2017. J Exp Orthop. 2019;6(1):9. doi: 10.1186/s40634-019-0177-5. [PubMed: 30805738]. [PubMed Central: PMC6389998].

3. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg. 2011;19(10):590-9. doi: 10.5435/00124635-201110000-00003. [PubMed: 21980024].




4. Song EK, Seon JK, Park SJ, Jeong MS. The complications of high tibial osteotomy: Closing- versus opening-wedge methods. J Bone Joint Surg Br. 2010;92(9):1245-52. doi: 10.1302/0301-620X.92B9.23660. [PubMed: 20798442].

5. Miller BS, Downie B, McDonough EB, Wojtys EM. Complications after medial opening wedge high tibial

osteotomy. Arthroscopy. 2009;25(6):639-46. doi: 10.1016/j.arthro.2008.12.020. [PubMed: 19501295].

6. Jabalameli M, Rahbar M, Radi M, Hadi H, Moradi A. Radiographic results of high tibial open wedge osteotomy. Iran J Surg. 2013;21(1). [In Persian].

7. Raymond LD, Laflamme GY, Ranger P, Zhim F, Girard J. Open-wedge retro-tubercular tibial osteotomy: An innovating technique. Rev Chir Orthop Reparatrice Appar Mot.

2007;93(6):588-93.doi:10.1016/s0035-1040(07)92681-1.

[PubMed: 18065868].

8. Hopwood S, Khan W, Agarwal S. The biplanar open wedge high tibial osteotomy preserving the tibial tubercle. J Orthop Sci. 2016;21(6): 786-90. doi: 10.1016/j.jos.2016.07.006. [PubMed: 27484856].

9. Park H, Kim HW, Kam JH, Lee DH. Open wedge high tibial osteotomy with distal tubercle osteotomy lessens change in patellar position. Biomed Res Int. 2017;2017:4636809. doi:

10.1155/2017/4636809. [PubMed: 28804716]. [PubMed Central: PMC5540386].

10. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: A ten- to 20-year follow-up. J Bone Joint Surg Br. 2008;90(5):592-6. doi: 10.1302/0301-620X.90B5.20386. [PubMed: 18450624].

11. Grimm NL, Lazarides AL, Amendola A. Tibial tubercle osteotomies: A review of a treatment for recurrent patellar instability. Curr Rev Musculoskelet Med. 2018;11(2):266-71. doi: 10.1007/s12178-018-9482-3. [PubMed: 29721692]. [PubMed Central: PMC5970117].

12. Phillips CL, Silver DA, Schranz PJ, Mandalia V. The measurement of patellar height: A review of the methods of imaging. J Bone Joint Surg Br. 2010;92(8):1045-53. doi: 10.1302/0301-620X.92B8.23794. [PubMed: 20675745].

13. Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ. Patellar infera after high tibial osteotomy. J Arthroplasty. 2001;16(2): 168-73. doi: 10.1054/arth.2001.20538. [PubMed: 11222889].

14. Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WC, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: A new technique. Knee. 2004;11(6):457-61. doi: 10.1016/j.knee.2004.02.002. [PubMed: 15581764].
Published
2020-07-20
How to Cite
1.
Saeb M, Khabiri S saeed, Yaghoubi M, Mousapour A, Mardanpour K, Safari-Faramani R, Shafiee A, hojabrian A, Rahimipour S. A Comparison of the results and prognosis of genovarum correction with open wedge osteotomy and open wedge osteotomy with sagital plane cutting methods in the treatment of patients with varus knee deformity. J Orthop Spine Trauma. 5(1):12-6.
Section
Research Articles