Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise

Abstract

Simultaneous bilateral opening-wedge high tibial osteotomies (OWHTOs), using the TomoFix fixation device and artificial bone wedges (beta-TCP) were performed on 20 knees of 10 patients with an average age of 67 years (range 53-75) at the time of the operation. We established an early weight-bearing exercise program during which patients were permitted partial weight-bearing exercise 1 week after osteotomy, with all patients performing full weight-bearing exercise at 3 weeks. The follow-up period was an average of 15 months (range 6-39). The American Knee Society Score and the Function Score were improved significantly from 46 +/- 8.1 to 92 +/- 6.8 points and 67 +/- 7.9 to 95 +/- 7.9 points, respectively. Prior to surgery, the average lateral femoro-tibial angle (FTA) during standing was 182 +/- 2.3 degrees (2 degrees anatomical varus) and significantly changed to 170 +/- 2.5 degrees (10 degrees valgus) at the time of follow-up. There were no cases of infection, non-union, or implant failure. Overall, this procedure was highly successfully in correcting knee malalignment in patients with medial compartmental osteoarthritis. In our study also, there was no evidence of correction loss, implant failure, collapse of the artificial bone wedges, or screw loosening. Simultaneous treatment of bilateral OWHTOs under a single administration of anesthesia appears to be superior to separate procedures of unilateral surgical procedures in providing the potential benefits of minimizing hospitalization, reducing costs and maximizing clinical outcomes for patients and institutions.