Eun-Kyoo Song; Jong-Keun Seon; Sang-Jin Park; Nam-Young Cho

doi:10.4055/jkoa.2009.44.3.336

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Song, Seon, Park, and Cho: Open Wedge High Tibial Osteotomy with Aescula® Plate

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(3): 336-343.

Published online: 18 June 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.3.336

Open Wedge High Tibial Osteotomy with Aescula® Plate

Eun-Kyoo Song, M.D., Jong-Keun Seon, M.D., Sang-Jin Park, M.D., Nam-Young Cho, M.D.

Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.

Address reprint requests to Sang-Jin Park, M.D. Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasun-eup, Hwasun-gun, Jeonnam 519-809, Korea. Tel: +82.61-379-7676, Fax: +82.61-379-7681, park5962@paran.com

Abstract

Purpose

This study is to evaluate chinical and radiological results of open wedge high tibial osteotomy using Aescula® plate.

Materials and Methods

Ninity one patients who have unicompartmental osteoarthritis with varus deformity were treated by open wedge high tibial osteotomy with Aescula® plate and followed up at least 2 years. Clinically, visual analogue scale (VAS), range of motion (ROM) and hospital for special surgery (HSS) score were evaluated. Radiologically, tibio-femoral angle, mechanical axis, medial proximal tibia angle and posterior slope were measured. All complications were also evaluated.

Results

During the follow-up VAS improved from 8.3 to 2.1, ROM were checked preoperatively from 1.3° to 137° and from 1.8° to 136.1° at last follow up. And HSS score improved from 76.8 to 91. Preoperative tibio-femoral angle was 0.4° of varus, mechanical axis 6.4° of varus, medial proximal tibia angle 84.4° and posterior slope 9.3°. Radiologic results at last follow up revealed significant improvements by 8.3° of valgus for tibio-femoral angle, 1.8° of valgus for mechanical axis and 90.1° for medial proximal tibia angle. Mean posterior slope was 10.4° which increased 1.1° compared with preoperative one. And there was one fixation failure that needed re-operation.

Conclusion

Open wedge high tibial osteotomy using Aescula® provided excellent clinical and radiological results at 2 years follow-up.

Keywords: Unicompartmental knee osteoarthritis, Open wedge high tibial osteotomy, Aescula® plate

Figures and Tables

Fig. 1

Aescula open wedge plate system. (A) Plate, (B) Screw, (C) Plate and screw.

Fig. 2

A comparision of tibial open wedge osteotomy. (A) Preoperative anteroposterior view with tibiofemoral angle. (B) Preoperative lateral view with posterior angle. (C) Teleoroentgenography with mechanical axis. (D) Postoperative antero-posterior view with tibiofemoral angle. (E) Postoperative lateral view with posterior angle. (F) Postoperative teleoroentgenography with mechanical axis.

Fig. 3

A procedure of high tibial open wedge osteotomy. (A) Skin incision below medial joint line. (B) Pes anserius tendon is identified and incised with Z-plasty fasion. (C) Identification of anterior border of medial collateral ligament. (D) Guide wire insertion under the fluoroscopy. (E) Osteotomy is performed along guider wire. (F) Gap measeurement and plate fixatioin.

Table 1

Charateristics of Patient Enrolled in the Current Study

Table 2

The Length of Posterior Plate

Table 3

Clinical Results Evaluated by VAS, ROM, HSS

^*indicate p<0.05; VAS, range of motion; HSS, hospital for special surgery; F/U, follow up.

Table 4

Radiological Results Evaluated by Tibiofemoral Angle, Mechanical Axis, Medial Proximal Tibial Angle, Posterior Slope

(-) indicate varus angle; ^*indicate p<0.05; ^†compare with preoperation; ^‡compare with preoperation; F/U, follow up.

Table 5

Posterior Slope Change between Rectangular and Wedge Shape Opening Group

Group A, rectangular shape opening group; Group B, wedge shape opening group.

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