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Medium- and long-term results of high tibial osteotomy using Garches external fixator and gait analysis for dynamic correction in varus osteoarthritis of the knee.

McClelland, D.; Barlow, D.; Moores, T.S.; Wynn-Jones, C.; Griffiths, D.; Ogrodnik, P.J.; Thomas, P.B.M.

Medium- and long-term results of high tibial osteotomy using Garches external fixator and gait analysis for dynamic correction in varus osteoarthritis of the knee. Thumbnail


Authors

D. McClelland

D. Barlow

T.S. Moores

C. Wynn-Jones

D. Griffiths

P.B.M. Thomas



Abstract

In arthritis of the varus knee, a high tibial osteotomy (HTO) redistributes load from the diseased medial compartment to the unaffected lateral compartment. We report the outcome of 36 patients (33 men and three women) with 42 varus, arthritic knees who underwent HTO and dynamic correction using a Garches external fixator until they felt that normal alignment had been restored. The mean age of the patients was 54.11 years (34 to 68). Normal alignment was achieved at a mean 5.5 weeks (3 to 10) post-operatively. Radiographs, gait analysis and visual analogue scores for pain were measured pre- and post-operatively, at one year and at medium-term follow-up (mean six years; 2 to 10). Failure was defined as conversion to knee arthroplasty. Pre-operative gait analysis divided the 42 knees into two equal groups with high (17 patients) or low (19 patients) adductor moments. After correction, a statistically significant (p < 0.001, t-test,) change in adductor moment was achieved and maintained in both groups, with a rate of failure of three knees (7.1%), and 89% (95% confidence interval (CI) 84.9 to 94.7) survivorship at medium-term follow-up. At final follow-up, after a mean of 15.9 years (12 to 20), there was a survivorship of 59% (95% CI 59.6 to 68.9) irrespective of adductor moment group, with a mean time to conversion to knee arthroplasty of 9.5 years (3 to 18; 95% confidence interval ± 2.5). HTO remains a useful option in the medium-term for the treatment of medial compartment osteoarthritis of the knee but does not last in the long-term. Cite this article: Bone Joint J 2016;98-B:601-7.

Citation

McClelland, D., Barlow, D., Moores, T., Wynn-Jones, C., Griffiths, D., Ogrodnik, P., & Thomas, P. (2016). Medium- and long-term results of high tibial osteotomy using Garches external fixator and gait analysis for dynamic correction in varus osteoarthritis of the knee. The Bone & Joint Journal, 98-B(5), 601 - 607. https://doi.org/10.1302/0301-620X.98B5.34875

Journal Article Type Article
Acceptance Date Apr 4, 2016
Publication Date May 3, 2016
Journal The Bone and Joint Journal
Print ISSN 2049-4394
Publisher British Editorial Society of Bone and Joint Surgery
Peer Reviewed Peer Reviewed
Volume 98-B
Issue 5
Pages 601 - 607
DOI https://doi.org/10.1302/0301-620X.98B5.34875
Keywords Garches, dynamic correction, high tibial osteotomy, long term follow-up
Publisher URL http://dx.doi.org/10.1302/0301-620X.98B5.34875

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