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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 11, 1459-1465.
doi: 10.1302/0301-620X.91B11.22614  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Fixation stability of opening- versus closing-wedge high tibial osteotomy

A RANDOMISED CLINICAL TRIAL USING RADIOSTEREOMETRY

J. W. H. Luites, MSc, Scientific Researcher1; J.-M. Brinkman, MD, Orthopaedic Resident2; A. B. Wymenga, MD, PhD, Orthopaedic Surgeon2; and R. J. van Heerwaarden, MD, PhD, Orthopaedic Surgeon3

1 Department of Research, Development & Education Department of Orthopaedics Radboud University Nijmegen Medical Centre, P. O. Box 910, 6500HB Nijmegen, The Netherlands.
2 Limb Deformity Reconstruction Unit, Department of Orthopaedics, Sint Maartenskliniek, P. O. Box 9011, 6500 GM Nijmegen, The Netherlands.
3 Limb Deformity Reconstruction Unit, Department of Orthopaedics, Sint Maartenskliniek Woerden, P. O. Box 8000, 3440 JD Woerden, The Netherlands.

Correspondence should be sent to Mr R. J. van Heerwaarden; e-mail: r.vanheerwaarden{at}maartenskliniek.nl

Valgus high tibial osteotomy for osteoarthritis of the medial compartment of the knee can be performed using medial opening- and lateral closing-wedge techniques. The latter have been thought to offer greater initial stability.

We measured and compared the stability of opening- and closing-wedge osteotomies fixed by TomoFix plates using radiostereometry in a series of 42 patients in a prospective, randomised clinical trial.

There were no differences between the opening- and closing-wedge groups in the time to regain knee function and full weight-bearing. Pain and knee function were significantly improved in both groups without any differences between them. All the osteotomies united within one year. Radiostereometry showed no clinically relevant movement of bone or differences between either group.

Medial opening-wedge high tibial osteotomy secured by a TomoFix plate offers equal stability to a lateral closing-wedge technique. Both give excellent initial stability and provide significantly improved knee function and reduction in pain, although the opening-wedge technique was more likely to produce the intended correction.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General