Razi Journal of Medical Sciences

    Introduction: Excellent results are obtained with high tibial osteotomy in patients suffering from the osteoarthritis of the medial compartment of the knee however, poor results have been reported in 10 to 50 percent of the cases. The aim of this study was to evaluate the probable factors influencing the outcome of high tibial osteotomy to let us select the proper cases for this surgery.

Patients and Methods: In this retrospective case – control study,57 high tibial osteotomies were performed by the open wedge method in 43 patients (16 males and 27 females, mean age = 54.5±7.8 years) between 2005 and 2007 as the treatment of medial compartment osteoarthritis of the knee. Mean follow-up time was 25±5 months. Factors including age, sex, previous lower limb surgery, history of long-term pain of the knee, obesity, smoking, widening of the medial compartment, tibial exophyte, complete tibial chondral destruction, medial meniscus damage, varus angle of more than 10 degrees, severe instability of the medial collateral ligament, and concurrent lateral compartment osteoarthritis were assessed and recorded before and after the surgery. Comparison between pre-operative and post-operative situations were performed using statistical analysis by scores obtained from KOOS in patients with or without the said factors. Data analysis was done using One-way ANOVA, independent samples t-test, and Mann-Whitney U-test.The difference between outcomes (with KOOS score) due to probable predicting factors was evaluated in patients with high tibial osteotomies.

Results: Eight complications were seen due to the surgery in one case reoperation was needed and one case underwent total knee replacement due to sustained severe pain. Mean angle of correction was 8.8±3.4 degree and mean time for healing of the osteotomy was 3.1±1.4 months. History of knee pain of more than 2 years and concurrent lateral compartment osteoarthritis were present along with many other factors in patients with poor results.

Conclusion: Choosing high tibial osteotomy as a method of treatment for osteoarthritis in cases which are predicted to have poor results, is only a costly decision and a delay in the correct therapeutic procedure. In this study we identified several factors that would influence the outcome.In this way, it could be used to screen patients and in case poor results are predicted, it would be better to carry out total knee replacement to prevent costly procedures and the burden of several surgeries.