Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases

Abstract

Introduction: A medial opening wedge high tibial osteotomy (HTO), where the osteotomy site is filled, is often preferred to a lateral closing osteotomy, but filling the defect can lead to certain complications.

Hypothesis: A medial opening HTO can be performed without filling the bone defect if fixation is carried out with a specially-designed stiff locking plate.

Patients and methods: Fifty-one patients, 37 to 72 years of age where followed prospectively and continuously from 2003 to 2006. A single surgical technique was used: medial opening HTO with locked plate fixation (TomoFix™, Synthes) but without filling the defect. The preoperative genu varum could not exceed 15°. The following were evaluated: time to return to weight-bearing, IKS functional score, long-leg standing film performed preoperative, postoperative and at follow-up to evaluate limb alignment and validate the precision of the correction and its stability over time. A measurement of the area of bone union in the osteotomy site was used to quantify the rate of union.

Results: Bone union occurred at 4.5 months on average; two cases of incomplete union (7%) were found and revised with an autograft at 7 and 9 months. Lower-limb alignment was 7.5° of varus on average before surgery (3° to 15° varus, SD=2.85) and 1.2° of valgus on average after the surgery (4° varus to 5° valgus, SD=1.78). The correction was maintained at 1 year post-surgery. The average IKS knee score went from 69±15.5 (range 25 to 96) before surgery to 90±7.4 (range 66 to 98) at follow-up (P=0.0001). Full weight-bearing without assistance was possible after 3 months on average (range 1.5 to 8, SD=1.21). Forty-seven patients (92%) were fully weight-bearing after 2 months. Forty-eight patients were able to return to work and sporting activities at the same or a higher level than before the procedure.

Discussion: Bone union seems to happen more slowly when the defect is filled; however, there are doubts about radiological evaluation of bone union in different published studies. When osteotomy defect was left unfilled in this study, union and filling of 4/5 of the osteotomy site was obtained in 4.2 months for 49 of the 51 cases. Fixation with the locking plate is reliable and provides stable correction and the option for early weight-bearing.