Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate
- 1 November 2006
- journal article
- research article
- Published by British Editorial Society of Bone & Joint Surgery in The Journal of Bone and Joint Surgery. British volume
- Vol. 88 (11), 1454-1459
- https://doi.org/10.1302/0301-620x.88b11.17743
Abstract
A prospective, randomised, controlled trial compared two different techniques of high tibial osteotomy with a lateral closing wedge or a medial opening wedge, stabilised by a Puddu plate. The clinical outcome and radiological results were examined at one year. The primary outcome measure was the achievement of an overcorrection of valgus of 4°. Secondary outcome measures were the severity of pain (visual analogue scale), knee function (Hospital for Special Surgery score), and walking distance. Between January 2001 and April 2004, 92 patients were randomised to one or other of the techniques. At follow-up at one year the post-operative hip-knee-ankle angle was 3.4° (± 3.6° sd) valgus after a closing wedge and 1.3° (± 4.7° sd) of valgus after an opening wedge. The adjusted mean difference of 2.1° was significant (p = 0.02). The deviation from 4° of valgus alignment was 2.7° (± 2.4° sd) in the closing wedge and 4.0° (± 3.6° sd) in the opening-wedge groups. The adjusted mean difference of 1.67° was also significant (p = 0.01). The severity of pain, knee score and walking ability improved in both groups, but the difference was not significant. Because of pain, the staples required removal in 11 (23%) patients in the closing-wedge group and a Puddu plate was removed in 27 (60%) patients in the opening-wedge group. This difference was significant (p < 0.001). We conclude that closing-wedge osteotomy achieves a more accurate correction with less morbidity, although both techniques had improved the function of the knee at one year after the procedure.Keywords
This publication has 15 references indexed in Scilit:
- Patellar height and the inclination of the tibial plateau after high tibial osteotomyThe Journal of Bone and Joint Surgery. British volume, 2005
- Complications in high tibial (medial opening wedge) osteotomyArchives of orthopaedic and trauma surgery, 2003
- Improvements in surgical technique of valgus high tibial osteotomyKnee Surgery, Sports Traumatology, Arthroscopy, 2003
- The whole leg radiographStanding versus supine for determining axial alignmentActa Orthopaedica, 2003
- The Role of Knee Alignment in Disease Progression and Functional Decline in Knee OsteoarthritisJAMA, 2001
- Patellar infera after high tibial osteotomyThe Journal of Arthroplasty, 2001
- Survivorship of the High Tibial Valgus Osteotomy A 10-to 22-Year Followup StudyClinical Orthopaedics and Related Research, 1999
- Hemicallotasis open-wedge osteotomy for osteoarthritis of the kneeThe Journal of Bone and Joint Surgery. British volume, 1999
- High Tibial OsteotomyClinical Orthopaedics and Related Research, 1990
- Proximal Tibial OsteotomyClinical Orthopaedics and Related Research, 1988