The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy |
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Authors: | Miklós Papp Zoltán Csernátony Sándor Kazai Zoltán Károlyi László Róde |
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Institution: | (1) Department of Orthopaedic Surgery, Borsod County Hospital, 72-76 Szentpéteri kapu str., Miskolc, 3501, Hungary;(2) Department of Orthopaedic Surgery, Medical and Health Science Center, University of Debrecen, 98. Nagyerdei krt, Debrecen, 4012, Hungary;(3) Estike str. 40, Miskolc, 3525, Hungary |
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Abstract: | High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically
demanding. From 1 January 1993 to 31 December 2000, combined osteotomy After the first osteotomy made 2 cm distally to the
joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The
distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.]
was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and
41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative
week, in the 12th postoperative month and at the time of the final follow-up (in group A—66.15 months, in group B—66.61 months).
We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of
the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida
and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of
the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall–Salvati ratio
remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change
of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of
the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition
of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head
was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835°),
than after closing wedge osteotomy (9.465°). Theoretically, the recurrence of the varus deformity, the increase of the valgus
alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful
conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined
osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss;
therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement. |
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Keywords: | Osteoarthritis of the knee High tibial osteotomy Combined osteotomy Closing wedge osteotomy Malalignment |
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