Description
Objectives: High tibial osteotomy (HTO ) has long been widely used in young patients for the treatment of osteoarthritis of the knee medial compartment with varus deformation, which helps to avoid early total arthroplasty.
Methods: During the period from 04.2014 to 09.2020, 48 patients were underwent medial open wedge high tibial osteotomy (MOW HTO) due to osteoarthrosis of the knee medial part with varus deformity.Of the 48 treated patients, 12 were men, and 36 were women. The average age of the patients was 53.3 ± 10.3 years. The body mass index of patients is 27.2 ± 3.5. Before the operation, the patient underwent anteroposterior X-rays of the lower extremity to determine the amount of varus deformation and a lateral X-ray in the position of knee flexion in the 30°. Limb deformation was determined according to the methods described by Hsu and Moreland. The height of the patella position was assessed according to the Blackburne-Peel method. The inclination of the proximal tibia was determined by the Moore-Harvey method.Consolidation in the osteotomy area was determined on radiographs according to the technique described by Staubli, assessing the percentage of consolidation of the osteotomy wedge.
The Lysholm scale and the subjective IKDS-2000 scale were used to evaluate the treatment results before surgery, after 6, 12 and 24 months after surgery. Results: After the operation, the line of the mechanical axis of the lower extremity passed along the segment between 50% and 70% of the lateral transverse size of the tibia articular surface.
Further examination of radiographs showed that patella baja was detected in 4 cases, the average Blackburne-Peel index was 0.82 ± 0.14. The Moore- Harvey index changed slightly (5.9 ± 2.9 before surgery vs. 4.8 ± 2.4 after surgery).
According to the method of Staubli at al., fusion in the osteotomy zone 6 weeks after the operation was 37 ± 14%, after 6 months - 73 ± 12%, after 12 months - 89 ± 8%, after 24 months - 95 ± 4% .
Excellent and good results were achieved in 67.5 % of cases. Eighty-six per cent of patients developed better clinical results 24 months later versus their preoperative state. After the above period, 67.5 % of patients returned to the level of their initial sports activity.
The results of treatment on the 24th month after the operation of MOW NTO according to the IKDC scale were divided into groups: A - 44%, B - 23%, C - 27% D - 4%.
Conclusions: MOW HTO using Puddu-type implants has proven to be a simple and effective operation. Our results show that recovery is long-term, its deadline does not come at 6 or even 12 months after surgery. In many patients, improvement was observed after 12 months. This fact is the basis for justifying the removal of the implant no earlier than the 24th month after the operation.
