High Tibial Osteotomy: An Educational Casuality?
2Orthopedic Department, Paris Mount Louis Private Hospital, France
3Orthopedic B Department, Hillel Yaffe Medical Center, Israel
Background:
High tibial osteotomy gradually disapeared from the surgical indications to treat varus gonarthrosis which is the main presentation of knee osteoarthritis.
It was outranked by total knee replacement and unicompatimental knee replacement. Unfortunately these latter procedures carry a certain percentage of dissatisfactions as
well as revision need, unique or repeated, not taking into account the eventuality of peri prosthetic joint infection . The cumulative morbidity or eventual mortality
following knee joint replacements forces the surgical community to revisit a procedure which, in the vast majority of cases, prevents the final use of a joint replacement.
Methods:
We undertook a retrospective analytic study on 98 casses of high tibial ostreotomies , with a minimal ten years follow up . All these cases could have been iinitially proposed to undergo a total knee replacement since the majority of them had some involvment of their patello femoral joint. All underwent a strictly calculated lateral wedge closing technique with mid shaft fibular osteotomy.
Results and Conclusion:
On this serie of 98 closing wedge valgus high tibial osteotomies with a follow-up between 10 and 30 years only two patients required a revision to a toal knee replacement : one ws required at fifteen years follow up and one at a seventeen years delay follow up. One of these two cases requiring revision had a minor imperfection in the initial high tibial osteotomy. This presentation will try to demonstrate that a well carried out high tibial osteotomy performed according to our technique should not be definitely discarded since it considerably reduce the need of total knee replacemnt , by the same token preventing eventual iatrogenic mobidity associated to it.