Osteotomy for gonarthrosis - with special reference to the tibial callus distraction technique

Abstract: Osteotomy is used for correction of the altered load on the gonarthrotic knee joint. It can be performed above or below the knee. Clinical results depend on the correction after bone healing. By tibial closed wedge osteotomy (HTO), the deformity is corrected peroperatively in contrast to tibial hemicallotasis osteotomy (HCO) where the correction is performed after surgery. Comparing the two methods, the precision was better after HCO but the clinical results were similar at follow-up. After one year, the radiographic alignment of the leg was better after HCO, as was the stability of the osteotomy measured by RSA. In 308 operations, the most common complication after HCO was minor pin-tract infection. It was registered in 157 cases. Pin-tract care and oral antibiotics were sufficient as treatment in most cases. A loose external pin implies a risk for pin-tract infection. Hydroxyapatite-coating (HA) of the pin threads increased the fixation. HA-coating is recommended for use in metaphyseal locations where the risk for pin loosening is higher. 11 complications requiring re-operation were registered after 32 distal femoral osteotomies for lateral gonarthrosis. HCO was studied as treatment for lateral gonarthrosis and advanced medial gonarthrosis. The 2-year results after 23 operations were similar to those after treatment for early medial gonarthrosis. In a matched study of knee arthroplasty, there was no increased radiostereometric migration of the tibial component after a previous tibial osteotomy.