Long-term outcome following high tibial osteotomy with tension bend principle

Background: High tibial osteotomy has been successfully performed on patients with varus gonarthrosis for many years now. The prospective study presented here serves to verify the long-term outcome of this procedure. Methods: A supratuberous high tibial osteotomy was carried out on 100 patients with varus gonarthrosis. Since then, 5 patients have died, and 6 patients could not be traced. The regaining rate was 94%. From a total of 89 patients with 101 operated knee joints, 46 were men and 43 women. The mean age at the time of surgery was 58 years. The patients were clinically and radiologically examined 10 years postoperatively and the knee score and function score ascertained according to the International Knee Society. Results: The knee score showed a statistically significant increase from 31 points prior to surgery to 79 points at the time of follow-up; the function score likewise increased from 46 points to 78 points. In addition, 77.5% of patients would undergo the same surgery again, while 79% of patients claimed their condition to have improved following surgery. The preoperative full-length weight-bearing radiograph demonstrated an axis shift in the varus position of on average 9.6degrees at 10 years postoperatively, an overcompensation in the valgus position of 1degrees on average. At the time of follow-up, 81% did not require repeat surgery of the knee. Conclusion: With a correct diagnosis and accurate surgical techniques, positive clinical and radiological long-term results can be expected. Therefore, high tibial osteotomy may constitute an important contribution to our algorithm in the treatment of varus gonarthrosis.