Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2020; 11(12): 606-614
Published online Dec 18, 2020. doi: 10.5312/wjo.v11.i12.606
Impact of medial open-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee
Sunil Sheshrao Nikose, Devashree Nikose, Aditya L Kekatpure, Shashank Jain, Kiran Saoji, Sridhar M Reddy
Sunil Sheshrao Nikose, Aditya L Kekatpure, Shashank Jain, Kiran Saoji, Sridhar M Reddy, Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India
Devashree Nikose, General Doctor, NKP Salve Institute of Medical Sciences, Nagpur 440019, Maharashtra, India
Author contributions: Nikose SS performed all osteotomies, participated in conceptualization, methodology, software, reviewing, editing, and supervision; Nikose D performed data curation, writing, original draft preparation, and formal analysis; Kekatpure AL provided supervision; Jain S participated in visualization and investigation; Saoji K provided software, validation, resources, project administration; Reddy SM wrote, reviewed and edited the manuscript; all the authors contributed to the process of concept, design, acquisition of data and/or analysis and interpretation of data; all the authors drafted the article and/or revised it critically for important intellectual content; all the authors approved the version to be published as per uniform requirements for manuscripts submitted to biomedical journals.
Institutional review board statement: All procedures performed in this study were in accordance with the ethical standards of the committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and were approved by the Datta Meghe Institute of Medical Sciences, Wardha, India (dated 30 May 2015).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data used to support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to information that might compromise the privacy of the research participants (patients).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sunil Sheshrao Nikose, MBBS, MS, Director SVL and Professor, Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Sawangi, Wardha 442001, Maharashtra, India. sunilnikose@gmail.com
Received: June 24, 2020
Peer-review started: June 24, 2020
First decision: August 22, 2020
Revised: August 31, 2020
Accepted: October 23, 2020
Article in press: October 23, 2020
Published online: December 18, 2020
Abstract
BACKGROUND

Most populations worldwide, who are used to squatting and sitting cross-legged for their activities of daily living, largely comprise the lower socioeconomic strata, thus making them candidates for exclusion for total knee arthroplasty. Proximal/high tibial osteotomy (HTO) is a preferred strategy for clinically symptomatic osteoarthritis (OA) with genu varum due to painful medial compartment OA which is not amenable to conservative measures.

AIM

To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India.

METHODS

A total of 65 knees in 56 patients with a mean age of 58.22 ± 5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018. The mean preoperative radiological angle of genu varum was 13.4°. Clinical outcomes were assessed by the range of movement, knee scores, pain scores, and functional scores. Radiographic studies were performed preoperatively and at regular intervals during the follow-up period.

RESULTS

All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years. The genu varum angle was overcorrected to approximately four degrees in all patients. There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively. Preoperative knee movements were restored in all patients. No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief.

CONCLUSION

Medial open-wedge HTO is a reliable, safe, practical, physiological, and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.

Keywords: High tibial osteotomy, Total knee arthroplasty, Genu varum, Osteoarthritis, Osteosynthesis, Knee Society Score

Core Tip: In recent times, unicompartment knee arthroplasty has been the procedure of choice for isolated medial compartment osteoarthritis in the developed world; however, this option is unsuitable for populations used to squatting and sitting cross-legged, and having greater physical demands on the knees. For these subsets of individuals, a physiological and biological procedure to correct the deformity and relieve pain in the long-term has been made possible by medial open-wedge high tibial osteotomy which does not compromise future knee surgery such as total knee arthroplasty if the situation demands.