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ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 60-67

Outcomes of medial opening wedge high tibial osteotomy following concomitant arthroscopic procedures in medial compartmental osteoarthritis of knee


1 Department of Orthopaedics, AFMS, New Delhi, India
2 Department of Community Medicine, AFMS, New Delhi, India
3 Department of Anaesthesiology, Rainbow Children’s Hospital, Bangalore, Karnataka, India
4 Department of Medical Informatics, AFMS, New Delhi, India

Correspondence Address:
Dr. Suresh Kumar Choudhary
Department of Orthopaedics, AFMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOASP.JOASP_32_21

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BACKGROUND: The purpose of this study was to analyze the outcome of concomitant arthroscopic procedures followed by medial opening wedge high tibial osteotomy (HTO) in medial compartment osteoarthritis (OA) of the knee. MATERIALS AND METHODS: Based on inclusion and exclusion criteria, a prospective observational study was carried out on 26 patients with medial compartment OA of the knee who underwent concomitant arthroscopic procedures followed by medial opening wedge HTO at one of the multispecialty hospitals in Northern India and were followed-up for one year. The mean age of the study population was 46.9 years. Preoperative values of pain score, functional score, range of motion (ROM), and tibiofemoral angle were compared with postoperative values at 6 weeks, 12 weeks, 24 weeks, and 1 year. A telephonic consultation at five-year post-op was carried out enquiring about activities of daily living and any need for knee replacement in near future. RESULTS: There was a significant improvement in terms of pain relief and functional outcome as per the Knee Society Score. The mean ROM was improved from 120.42° preoperatively to 127.96° postoperatively. The targeted tibiofemoral angle was achieved and maintained at a one-year follow-up. The osteotomy site healed well in all patients. None of the patients developed, postoperative compartment syndrome, patella baja, instability, or peroneal palsy which are otherwise known complications. On telephonic consultation at the latest follow-up (five-year postoperative) all are comfortable with activities of daily living and none of them seek knee replacement in immediate future. In our study, one patient (3.8%) developed surgical site infection, which was treated with intravenous antibiotics and removal of the implant after the union and one patient (3.8%) had painful terminal movement at final follow-up. CONCLUSION: Concomitant arthroscopic procedures followed by medial opening wedge HTO is a joint preserving surgery with good to excellent outcomes for the treatment of the refractory pain and disability caused by OA of knee involving the medial compartment in a mal-aligned limb in young and middle-aged active patients. The deformity correction achieved by medial opening wedge HTO is translated in terms of comfort achieved in daily living activities, relief of symptoms of OA, and improvement in function with an unimpeded lifestyle. We also conclude that overtreatment of isolated medial compartment OA of the knee can be aborted by doing HTO, which can definitely buy time before the more radical procedure is unavoidable, it cannot the risk of future total knee replacement be prevented.


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