Logo of The Journal of Bone & Joint Surgery (Br)
Quick search:        
          Advanced Search
Guest Access | Sign In
Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 11, 1454-1459.
doi: 10.1302/0301-620X.88B11.17743  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Japanese
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow My Folders
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via ISI Web of Science (6)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brouwer, R. W.
Right arrow Articles by Verhaar, J. A. N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Brouwer, R. W.
Right arrow Articles by Verhaar, J. A. N.

Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate

A ONE-YEAR RANDOMISED, CONTROLLED STUDY

R. W. Brouwer, PhD, Orthopaedic Surgeon1; S. M. A. Bierma-Zeinstra, PhD, Biomedical Scientist2; T. M. van Raaij, MD, Orthopaedic Surgeon3; and J. A. N. Verhaar, PhD, Orthopaedic Surgeon3

1 Department of Orthopaedics, Martini Hospital, PO Box 30033, 9700 RM Groningen, The Netherlands.
2 Department of General Practice, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
3 Department of Orthopaedics, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Correspondence should be sent to Dr R. W. Brouwer; e-mail: r.w.brouwer{at}mzh.nl

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.




eLetters:

Read all eLetters

Osteotomy for medial compartment arthritis of the knee
Alam M, et al.
J Bone Joint Surg Br Online, 6 Dec 2006 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General