Anatomical locked plate versus Ilizarov’s ring fixator for high tibial osteotomy in medial compartment osteoarthritic knee: A pilot study

Objectives: The medial or lateral compartment of the knee experiences an aberrant distribution of weight-bearing forces due to improper malalignment, causing pain and functional limitation. Our investigation aimed to compare clinical and radiological outcomes after treatment of varus knees with medial compartment osteoarthritis (MCOA) using acute correction by medial open wedge high tibial osteotomy (MOWHTO) fixed with TomoFix versus gradual correction with an Ilizarov fixator. Methods: A prospective pilot study involving 39 patients (40 knees) presenting with medial knee joint pain due to varus knee and MCOA, who were treated with MOWHTO participated. Two patient groups were formed: Group A received acute correction with internal fixation by TomoFix plate, and group B was treated with gradual correction using the Ilizarov method. Both groups followed up for a full year. Results: At final follow-up, both groups experienced a significant decrease in tibial slope, with an average of 4.90° in group A and 4.75° in group B. Both groups experienced a significant increase in mechanical medial proximal tibial angle, with group A achieving an average correction of 9.9° and group B achieving an average correction of 10.9°. Regarding clinical evaluation, the Oxford Knee Score demonstrated significant improvement in both groups, with averages of 14.8 in group A and 15.9 in group B. Conclusion: Based on the outcomes and complication rates, both methods are considered valid options for safe and effective surgical management for knee MCOA. They improve knee function, alignment, and achieve high patient satisfaction. However, each method has distinct advantages and disadvantages.