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abstract
In a consecutive series, 103 knees were treated with combined osteotomy. From these 103 knees, 80 knees were studied. Mean follow-up was 54.15 months (range: 1 3-96 months). After the first osteotomy is made 2 cm distal Iy to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial head/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. The result was excellent in 44%, good in 45%, and poor in 1 1 % of the knees.
High tibial osteotomy has long been used as surgical treatment for medial osteoarthritis of the knee.1"5 Closing-wedge,6,7 dome,8 and opening-wedge9"11 osteotomies are widely used. Recently, opening-wedge tibial osteotomy with hemicallotasis has become popular.12"14 The success rate of the high tibial osteotomy at 5 years is 80%-90% but the result of the high tibial osteotomy deteriorates over time.2,3,15"25,26
Clinical results can be affected by me elapsed time since the osteotomy, patient age,3"22,27 the degree of preoperative varus deformity,3-28 preoperative flexion arc,22 relative body weight,2,19,22,26 the degree of destructive changes of the medial compartment,16,24,28 previous medial menisectomy,29 me correction of axial alignment,* preoperative loss of knee extension,17 and presence of a lateral tibial thrust.22
Total knee arthroplasty (TKA) is not uncommon after high tibial osteotomy.3,34 Certain technical problems must be considered in performing TKA after high tibial osteotomy because of scarring of soft tissues and malposition of the tibial plateau. The major difficulty is scarring between me osteotomy site and me surrounding soft tissues, which makes me subperiosteal exposure of me proximal tibia more difficult. Shortening of me patellar ligament makes eversión of me patella difficult as well.35,36 These disadvantages are associated with all types of high tibial osteotomy.
After closing-wedge osteotomy, considerable lateral tibial metaphyseal bone loss frequently develops. This allows only a minimal lateral tibial bone resection and requires use of a tiiicker tibial component to restore die joint line during arthroplasty. Severe defects of me lateral tibial bone may require bone grafting.37"40 After closing-wedge osteotomy, removing a laterally-based bone wedge can lead to considerable lateral overhang of me tibial plateau, which can cause impingement of the peg of...