Clinical and radiological outcomes of high tibial osteotomy with combined fixator-assisted nailing and subtubercle tibial osteotomy

Abstract

Objective: The aim of this study was to assess the clinical and radiological results of our high tibial osteotomy technique combining fixator-assisted nailing and subtubercle tibial osteotomy in varus malalignment. Methods: This was a retrospective study of a consecutive series of 32 knees in 32 patients (2 follow-up loss' 12 males and 18 females; mean age at the time of operation: 50.6 +/- 7.8 (36-62) years) operated on between 2014 and 2016. Radiographic and clinical measurements were assessed pre- and postoperatively. Kolmogorov-Smimov, paired t and Wilcoxon rank tests were used in the statistical analyses. Results: The mean follow-up period was 36.1 +/- 8.15 (31-53) months, the mean duration of the hospital stay was 3.6 +/- 0.1 (2-6) days, and the mean Kellgren-Lawrence score was 2.4 +/- 0.6 (2-4). Time to bony union was an average of 16.17 (12-29) weeks. Compared to the preoperative mechanical medial proximal tibial angle, femorotibial angle and mechanical axis deviation measurements, all the postoperative values showed significant changes (p<0.01). However, there was no statistical difference between the preoperative and postoperative tibial slopes (p>0.05), and the postoperative Caton-Deschamps index did not show a meaningful change (p>0.05). The postoperative visual analog scale, Knee Society Score, and Modified Hospital for Special Surgery Knee Scoring System measures showed significant improvement compared to the preoperative values (p<0.01). The postoperative walking distance increased to 1137.50 +/- 845.1 meters, from 359.4 +/- 306.2 meters (p<0.01). Conclusion: This percutaneous technique is minimally invasive, corrects the alignment in two planes, and does not affect patellar height. We believe that this technique could be a promising alternative to other knee preserving surgeries in correcting varus malalignment.