Vol 44 # 2 June 2012 - Kma.org.kw

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93 Proximal Tibial Osteotomy in Medial Compartment Osteoarthritis: How High is High? June 2012 Fig. 1a Fig. 1b Fig. 1c Fig. 1a. Lateral closing-wedge high tibial osteotomy. (b) Anteroposterior radiograph of a 56-year-old female patient in the 5 th post-operative year. (c) Lateral radiograph of the same patient. Performing a HTO with the correct technique on a suitable patient is the basis for a successful result. The selection of the type of osteotomy should take into consideration the patient, the disease and joint characteristics. For the treatment of MCOA there should be an “a la carte” approach, with each case being considered according to the state of the deformity [2] . In this article, the relationship between the nomenclature and the different techniques of proximal tibial osteotomy with varying biomechanics is discussed. HISTORY History of osteotomy of the knee Osteotomy of the proximal tibia has been used for more than a century to correct angular deformity in the setting of rickets, poliomyelitis, and post-traumatic situations [24] . The first known report on osteotomy performed on the tibia was written in 1851 by Joseph Anton von Mayer [25] . Mayer named the operation “resection tibiae cuneiformis” and between the years 1839 - 1854 he performed 20 osteotomies on ricketsinduced deformities [26,27] . Wardle stated that osteotomy Fig. 2a Fig. 2b Fig. 2c Fig. 2 a: Medial opening wedge high tibial osteotomy. (b) Anteroposterior radiograph of 51-year-old female patient in the 2 nd post-operative year. (c) Lateral radiograph of the same patient.
June 2012 KUWAIT MEDICAL JOURNAL 94 Fig. 3: “Barrel vault” dome tibial osteotomy performed proximal to the tibial tuberosity Fig. 4: “Ball and socket” dome tibial osteotomy performed distal to the tibial tuberosity of the tibia combined with division of the fibula had been done in Liverpool since 1928 [28] . The surgeons who practised it at that time usually had to deal with deformity of the knee in adults, as a consequence of childhood rickets. The standard textbooks of the first half of the 20 th century did not discuss realignment. Arthur Steindler, Paul Collanna, and Willis Campbell did not even refer to tibial osteotomy for treatment of painful osteoarthritis of the knee [29] . Osteotomy for treatment of osteoarthritis of the knee in modern English literature was first reported by Jackson in 1958 at the Joint Meeting of the Orthopedic Associations [12] . In 1961, Jackson and Waugh were the first to publish their results on the treatment of osteoarthritis of the knee with a tibial osteotomy [13] . They reported that they were inspired by the success of an intertrochanteric osteotomy for relieving pain in the osteoarthritic hip. The operation had been performed both in Liverpool and other centers, and there were published results relating to its use in the treatment of the osteoarthritic knee joint [13] . Jackson and Waugh described “balland-socket” dome tibial osteotomy performed distal to the tibial tuberosity for osteoarthritis (Fig. 4). In 1961, Smillie [14] reviewed his experience of linear osteotomy of the tibial table for the correction of genu recurvatum, genu varum and genu valgum deformities of epiphysial origin. He performed the osteotomy about one centimetre below the articular surface and concluded that there were possible applications for his operation in selected cases of osteoarthritis. In 1962, Wardle [15] published his results of a tibial osteotomy done transverse and about four inches distal to the tibial tubercle. In 1964, Gariepy [16] described high tibial valgus osteotomy, a closing wedge technique performed proximal to the tibial tubercle that was further modified and popularized by Coventry in his classic paper published in 1965 [17] . This technique has not been modified since it was first reported by Gariepy in 1960 [30] . Various other forms of closing wedge osteotomy have also been described [20,21] . Wagner [20] in 1977, described an oblique metaphyseal proximal tibial osteotomy just below the tibial tubercle. A medial opening wedge osteotomy proximal to the tibial tubercule was first applied in 1951 by Debeyre et al [31] for MCOA. In 1987 Hernigou et al [19] published a 10 - 13 year follow-up of 93 patients operated on with this technique. Puddu et al [32] and Lobenhoffer and Agneskirchner [3] described a modified opening wedge osteotomy in 2000. Turi et al [33] developed the technique of progressive opening wedge osteotomy by hemicallotasis in 1987, and this method was subsequently modified by other authors [5,6,34,35] . This osteotomy can be performed above the tibial tubercle or at its distal part. The dome or curviplane high tibial osteotomy was introduced by Blaimont [31] in 1969 and popularized by Maquet [18] in 1976. He described a “barrel vault osteotomy” similar to the “ball-and-socket” osteotomy of Jackson. However, this osteotomy is proximal to the tibial tubercle. It is semicylindrical, and its concavity is downward, circumscribing the tibial tuberosity. Paley and Tetsworth [36] , in a detailed analysis of advances in the diagnosis and treatment of lower limb deformities
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