Skip to main content
SpringerLink
Log in

Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of our study was to compare clinical and radiological results of two groups of patients treated for medial compartment osteoarthritis of the knee with either conventional or computer-assisted open-wedge high tibial osteotomy (HTO). Goals of surgical treatment were a correction of the mechanical axis between 2° and 6° of valgus and a modification of posterior tibial slope between −2° and +2°.

Methods

Twenty-four patients (27 knees) affected by varus knee deformity and operated with HTO were prospectively followed-up. They were randomly divided in two groups, A (11 patients, conventional treatment) and B (13 patients, navigated treatment). The American Knee Society Score and the Modified Cincinnati Rating System Questionnaire were used for clinical assessment. All patients were radiologically evaluated with a comparative lower limb weight-bearing digital radiograph, a standard digital anteroposterior, a latero-lateral radiograph of the knee, and a Rosenberg view.

Results

Patients were followed-up at a mean of 39 months. Clinical evaluation showed no statistical difference (n.s.) between the two groups. Radiological results showed an 86% reproducibility in achieving a mechanical axis of 182°–186° in group B compared to a 23% in group A (p = 0.0392); furthermore, in group B, we achieved a modification of posterior tibial slope between −2° and +2° in 100% of patients, while in group A, this goal was achieved only in 24% of cases (p = 0.0021).

Conclusion

High tibial osteotomy with navigator is more accurate and reproducible in the correction of the deformity compared to standard technique.

Level of evidence

Therapeutic study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Agneskirchner J, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Arch Orthop Trauma Surg 124:575–584

    Article  PubMed  CAS  Google Scholar 

  2. Bae DK et al (2009) Closed-wedge high tibial osteotomy using computer-assisted surgery compared to the conventional technique. J Bone Joint Surg Br 91:1164–1171

    Article  PubMed  CAS  Google Scholar 

  3. Billings A, Scott DF, Camargo MP, Hofman AA (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation and early motion. J Bone Joint Surg Am 82:70–79

    PubMed  CAS  Google Scholar 

  4. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87:1227–1232

    Article  PubMed  CAS  Google Scholar 

  5. Chae D, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW (2008) Tibial slope and patellar height after opening wedge high tibial osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133

    Article  PubMed  Google Scholar 

  6. Coventry MB (1979) Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long-term results. Orthop Clin North Am 10:191–210

    PubMed  CAS  Google Scholar 

  7. Coventry MB, Bowman PW (1982) Long-term results of upper tibial osteotomy for degenerative arthritis of the knee. Acta Orthop Belg 48:139–156

    PubMed  CAS  Google Scholar 

  8. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201

    PubMed  CAS  Google Scholar 

  9. Cullu E, Aydogdu S, Alparslan B, Sur H (2005) Tibial slope changes following dome-type high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:38–43

    Article  PubMed  Google Scholar 

  10. Flecher X, Parratte S, Aubaniac J-M, Argenson J-NA (2006) A 12–28-year follow-up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96

    Article  PubMed  Google Scholar 

  11. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608

    PubMed  CAS  Google Scholar 

  12. Gebhard F, Hufner T, Grutzner PA, Stockle U, Imhoff AB, Lorenz S, Ljungqvist J, Keppler P, AO CSEG (2011) Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Arch Orthop Trauma Surg 131:297–302

    Article  PubMed  Google Scholar 

  13. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382

    Article  PubMed  Google Scholar 

  14. Gunes T, Sen C, Erdem M (2007) Tibial slope and high tibial osteotomy using the circular external fixator. Knee Surg Sports Traumatol Arthrosc 15:192–198

    Article  PubMed  Google Scholar 

  15. Haddad F, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15:597–603

    Article  PubMed  CAS  Google Scholar 

  16. Hankemeier S, Gosling T, Richter M, Hufner T, Hochhausen C, Krettek C (2006) Computer-assisted analysis of lower limb geometry: higher intraobserver reliability compared to conventional method. Comput Aided Surg 11:81–86

    PubMed  CAS  Google Scholar 

  17. Hankemeier S, Hufner T, Wang G et al (2005) Navigated intraoperative analysis of lover limb alignment. Arch Orthop Trauma Surg 125:531–535

    Article  PubMed  Google Scholar 

  18. Hankemeier S, Hufner T, Wang G et al (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921

    Article  PubMed  CAS  Google Scholar 

  19. Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year followup study. J Bone Joint Surg Am 69:332–354

    PubMed  CAS  Google Scholar 

  20. Hinterwimmer S et al (2011) Control posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39:851–856

    Article  PubMed  Google Scholar 

  21. Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load bearing distribution at the knee. Clin Orthop Relat Res 255:215–227

    PubMed  Google Scholar 

  22. Iorio R, Vadalà A, Giannetti S, Pagnottelli M, Di Sette P, Conteduca F, Ferretti A (2010) Computer-assisted high tibial osteotomy: preliminary results. Orthopaedics 33:82–86

    Article  Google Scholar 

  23. Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis: a long-term follow-up study. J Bone Joint Surg Am 66:1040–1048

    PubMed  CAS  Google Scholar 

  24. Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72:238–244

    PubMed  CAS  Google Scholar 

  25. Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 43:746–751

    PubMed  Google Scholar 

  26. Jacobi M, Wahl P, Jakob RP (2010) Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sport Traumatol Arthrosc 18:200–203

    Article  Google Scholar 

  27. Jakob RP, Murphy SB (1992) Tibial osteotomy for varus gonarthrosis: indication, planning and operative technique. Instr Course Lect 41:87–93

    PubMed  CAS  Google Scholar 

  28. Jung K, Kim SJ, Lee SC, Song MB, Yoon KH (2008) ‘Fine tuned’ correction of tibial slope with a temporary external fixator in opening wedge high-tibial osteotomy. Knee Surg Sports Traumatol Athrosc 16:305–310

    Article  Google Scholar 

  29. Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplasty 16:168–173

    Article  PubMed  CAS  Google Scholar 

  30. Kendoff D, Lo D, Goleski P, Warkentine B, O’Loughlin PF, Pearle AD (2008) Open wedge tibial osteotomies influence on axial rotation and tibial slope. Knee Surg Sports Traumatol Arthrosc 16:904–910

    Article  PubMed  CAS  Google Scholar 

  31. Keppler P, Gebhard F, Grutzner PA et al (2004) Computer aided high tibial open wedge osteotomy. Injury 35:S-A68–S-A78

    Article  Google Scholar 

  32. Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porus hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85:78–85

    Article  PubMed  Google Scholar 

  33. Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444

    Article  PubMed  Google Scholar 

  34. Lerat JL (2000) Osteotomies dans le gonarthrose. Cahiers d’enseignement. Elsevier, Paris, pp 165–201

    Google Scholar 

  35. Lerat J, Doyen B, Garin C, Mandrino A, Besse JL, Brunet-Guedj E (1993) Laxité antérieure et arthrose interne du genou. Résultats de la reconstruction du ligament croisé antérieure associé à une osteotomie tibiale. Rev Chir Orthop 79:365–374

    PubMed  CAS  Google Scholar 

  36. Liu W, Maitland ME (2003) Influence of anthropometric and mechanical variations on functional instability in the ACL deficient knee. Ann Biomed Eng 31:1153–1161

    Article  PubMed  Google Scholar 

  37. Lootvoet L, Massinon A, Rossillon R, Himmer O, Lambert K, Ghosez JP (1993) Upper tibial osteotomy for gonarthrosis in genu varum. Apropos of a series of 193 cases reviewed 6 to 10 years later. Rev Chir Orthop 79:375–384

    PubMed  CAS  Google Scholar 

  38. Marti C, Gautier E, Wachtl SW, Jakob R (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372

    Article  PubMed  Google Scholar 

  39. Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop 229:193–200

    PubMed  Google Scholar 

  40. Maurer F, Wassmer G (2006) High tibial osteotomy: does navigation improve result? Orthopedics 29:S130–S132

    PubMed  Google Scholar 

  41. Menetry J, Paul M (2004) Moglichkeiten der computergestutzen navigation bei kniegelenknahen osteotomien. Orthopade 33:224–228

    Article  Google Scholar 

  42. Moyad TF et al (2008) Opening wedge high tibial osteotomy: a novel technique for harvesting autograft bone. J Knee Surg 21:80–84

    PubMed  Google Scholar 

  43. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to 22-year follow-up study. Clin Orthop Relat Res 367:18–27

    Article  PubMed  Google Scholar 

  44. Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: The 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387

    Article  PubMed  Google Scholar 

  45. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465

    PubMed  CAS  Google Scholar 

  46. Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthritis. A 10- to 21-year follow-up study. Clin Orthop Relat Res 353:185–193

    Article  PubMed  Google Scholar 

  47. Rodner C, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (2006) Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibio-femoral contact pressure. Am J Sports Med 34:1431–1441

    Article  PubMed  Google Scholar 

  48. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28:s1269–s1274

    PubMed  Google Scholar 

  49. Schallberger A, Jacobi M, Wahl P, Jakob RP (2011) 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 19:122–127

    Article  Google Scholar 

  50. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195

    Article  PubMed  CAS  Google Scholar 

  51. Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30:S127–S131

    PubMed  Google Scholar 

  52. Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85-A:469–474

    PubMed  Google Scholar 

  53. Wiehe R, Becker U, Bauer G (2007) Computer-assisted open-wedge osteotomy. Z Orthop Unfall 145:441–447

    Article  PubMed  CAS  Google Scholar 

  54. Yamamoto Y, Ishibashi Y, Tsuda E, Tsukada H, Kimura Y, Toh S (2008) Validation of computer-assisted open-wedge high tibial osteotomy using three-dimensional navigation. Orthopedics 31(10 Suppl 1)

  55. Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195

    PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest with this study.

Author information

Authors and Affiliations

  1. Orthopaedic Unit and “Kirk Kilgour” Sports Injury Centre, S. Andrea Hospital, University of Rome “Sapienza”, Largo Olgiata 15, isola 75 edificio 3/2, 00123, Rome, RM, Italy

    R. Iorio, M. Pagnottelli, A. Vadalà, S. Giannetti, P. Di Sette, P. Papandrea, F. Conteduca & A. Ferretti

Authors
  1. R. Iorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Pagnottelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Vadalà
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Giannetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Di Sette
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Papandrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Conteduca
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Ferretti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Pagnottelli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iorio, R., Pagnottelli, M., Vadalà, A. et al. Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques. Knee Surg Sports Traumatol Arthrosc 21, 113–119 (2013). https://doi.org/10.1007/s00167-011-1785-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-011-1785-5

Keywords

Search

Navigation