Outcomes of Open Wedge High Tibial Osteotomy with Puddu Plate, with a Minimum Follow-up of 5 Years

DOI: https://doi.org/10.15417/issn.1852-7434.2024.89.5.1475
Keywords: Tibial valgus osteotomy, tibial opening wedge osteotomy, Puddu plate, genu varum, medial compartment osteoarthritis

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.

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Author Biographies

Daniel Porcelli, Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Juan Kenny, Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Juan Miguel Del Castillo, Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Luis Francescoli, Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Rogelio Rey, Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay
Clínica de Traumatología y Ortopedia, Universidad de la República, Montevideo, Uruguay

References

Han JH, Hyuk J, Nikhl Y, Dong NB, Suh W, Seong J, et al. Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy. Knee Surg Sport Traumatol Arthrosc 2016;24(8):2567-77. https://doi.org/10.1007/s00167-015-3807-1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Published
2024-10-17
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
Issue
Vol 89 No 5 (2024): ACARO
Section
Clinical Research
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