Acta Orthopaedica et Traumatologica Turcica
Research Article

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


Department of Orthopaedics and Traumatology, Sakarya University, School of Medicine, Sakarya, Turkey


Department of Orthopaedics, Bahçeşehir University, School of Medicine, İstanbul, Turkey


Vakıf Guraba University Hospital, İstanbul, Turkey

AOTT 2020; 54: 89-96
DOI: 10.5152/j.aott.2020.01.130
Read: 1085 Downloads: 451 Published: 02 March 2020

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-Smirnov, 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.

Level of Evidence: Level IV, Therapeutic Study

Cite this article as: Bayam L, Erdem M, Gülabi D, Erdem AC, Uyar AÇ, Kochai A. Clinical and radiological outcomes of high tibial osteotomy with combined fixator-assisted nailing and subtubercle tibial osteotomy. Acta Orthop Traumatol Turc 2020; 54(1): 89-96.

ISSN 1017-995X EISSN 2589-1294