Evaluation of Final Outcomes after High Tibial Osteotomies in the Treatment of Osteoarthritis

Background: High tibial osteotomy (HTO) and uni-compartmental knee arthroplasty are both treatment options for isolated uni-compartmental osteoarthritis (OA) of the knee and Knee joint instability. Before the advent of knee arthroplasties, HTO was the most commonly performed surgical procedure for knee OA. HTO is a well-established procedure used to treat uni-compartmental conditions like overload or osteoarthritis by shifting the mechanical axis of the knee, thereby realigning the load distribution. This realignment can help reduce pain, improve function, and potentially slow the progression of osteoarthritis. Aim of the Study: To analyse the final outcome of the High Osteotomy in Osteoarthritis patients after a follow up of 2 years. Materials: 29 consecutive patients with Osteoarthritis patients attending the Department of Orthopedics, from May 2022 to August 2024 were included in a prospective case series study. All the patients were graded according to Kellgren Lawrence classification with radiological evidence of Osteoarthritis with valgus and/or varus deformities and medial compartmental osteoarthritis (OA). Patients aged between 45 years and 65 years were included. Patients with high-demand activity levels without running or jumping were included. Patients with varus mal-alignment less than 15° were included. Patients with metaphyseal varus of the tibia greater than 5° were included. Patients with full range of motion and normal lateral and patella-femoral compartments were included. Deformity analysis was based on full-leg weight-bearing radiographs, either digitally or on paper. Arthroscopy was done initially to assess the status of the cartilage and menisci, especially in the lateral compartment. Wherever necessary, medial meniscus was resected, smoothing of the cartilage done and ablation of osteophytes were done to address any extension deficits. All the patients were followed up for 2 years. Results: 29 patients were treated with HTO, with an average age of 45.62±5.35 years. The average osteotomy opening was 10.8 mm, and no cases of secondary loss of correction occurred. One patient required a reoperation shortly after the initial procedure due to overcorrection, which was corrected by removing distal locking screws, adjusting the leg axis, and securing the plate with bi-cortical locking screws. Two patients experienced late infection and soft-tissue irritation 4 months postoperatively, but after plate removal and antibiotic treatment, the further clinical course was complication-free. Conclusions: Realignment osteotomy remains a critical treatment option for early to medium-grade varus medial compartment osteoarthritis (OA). Open-wedge high tibial osteotomy (HTO) utilizing optimal surgical techniques (including bi-planar metaphyseal osteotomy) and fixation with the TomoFix internal plate fixator has proven to be effective in treating uni-compartmental gonarthrosis, even in the absence of bone grafts or substitutes. The complication rate is low, patients achieve full weight-bearing quickly, and the medium-term results are promising.