rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-615-624rsp-3083Research ArticleРЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯORTHOPEDIC RHEUMATOLOGY AND REHABILITATIONСравнительный анализ результатов и осложнений двух методов выполнения открывающей угол высокой тибиальной остеотомииComparative analysis of the results and complications of two methods of the open wedge high tibial osteotomyhttps://orcid.org/0000-0002-3745-0924БяликВ. Е.BialikV. E.

Бялик Валерий Евгеньевич

115522, Российская Федерация, Москва, Каширское шоссе, 34а

Valerii Bialik

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

DoctorBjalik@yandex.ruhttps://orcid.org/0000-0001-8563-0631МакаровС. А.MakarovS. A.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7017-0898АлексееваЛ. И.AlekseevaL. I.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7938-1536БяликЕ. И.BialikE. I.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7179-8174НестеренкоВ. А.NesterenkoV. A.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-6847-6396НурмухаметовМ. Р.NurmukhametovM. R.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202131102021595615624Copyright © Бялик В.Е., Макаров С.А., Алексеева Л.И., Бялик Е.И., Нестеренко В.А., Нурмухаметов М.Р., 20212021Бялик В.Е., Макаров С.А., Алексеева Л.И., Бялик Е.И., Нестеренко В.А., Нурмухаметов М.Р.Bialik V.E., Makarov S.A., Alekseeva L.I., Bialik E.I., Nesterenko V.A., Nurmukhametov M.R.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3083

Цель исследования – сравнить результаты и осложнения открывающей угол высокой тибиальной остеотомии (ОУВТО), проводившейся с использованием стандартной методики и при помощи разработанного метода выполнения операции с применением оригинального фиксатора.Материалы и методы. В исследование включены 73 пациента с первичным и вторичным остеоартритом (ОА) коленного сустава (КС) I–III стадии, которые были разделены на две группы. В первую группу вошли 43 больных, которым с 2005 по 2019 гг. было выполнено 46 ОУВТО по стандартной методике с применением коротких пластин с фиксированным спейсером (в 5 случаях – Puddu I поколения, в 24 – Puddu II поколения, в 17 – Osteomed) и костной пластикой. Во вторую группу включены 30 пациентов, которым в 2018–2020 гг. осуществили ОУВТО с использованием разработанной хирургической техники и оригинального фиксатора. Для оценки результата изучали изменение интенсивности боли по визуальной аналоговой шкале, а также состояние КС по шкале Knee Society Score до операции, по прошествии 3 месяцев и 1 года после ОУВТО.Результаты. В 1-й группе через 1 год после ОУВТО был получен отличный результат в 43,5% случаев, хороший – в 41,3%, удовлетворительный – в 15,2% случаев. Во 2-й группе отличный, хороший и удовлетворительный результат получен в 59,3%, 33,4% и 7,3% случаев соответственно. В 1-й группе у 15 (32,7%) пациентов было диагностировано 26 осложнений, во 2-й группе – 5 осложнений у 5 (16,6%) пациентов.Выводы. Применение разработанной хирургической техники и оригинального фиксатора позволило увеличить число отличных и хороших результатов лечения с 84,8 до 92,7% и уменьшить количество осложнений, связанных с ОУВТО, с 32,7 до 16,6%.

Objective – to compare the results and complications of open wedge high tibial osteotomy (OWHTO) in patients operated on according to the standard technique and using the developed method of performing the operation using the original fixator.Materials and methods. 73 patients with primary and secondary OA of the knee I–III stages were recruited into the study, which were divided into 2 groups. Group 1 consisted of 43 patients, who underwent 46 OWHTO from 2005 to 2019 using the standard technique using short plates with a fixed spacer (Puddu I (5 times) and II generation (24 times), Osteomed (17 times)) and bone grafting. Group 2 consisted of 30 patients who were operated on in 2018– 2020 using the developed surgical technique and the original fixator. To assess the result, we studied the change in pain according to the Visual Analog Scale (VAS), as well as the functional (FS) and objective scores (OS) of the knee according to the Knee Society Score (KSS) before surgery, after 3 months and 1 year after OWHTO.Results. In group 1, one year after OWHTO, the results were obtained: excellent in 43.5% of cases, good – in 41.0% and satisfactory – in 15.2% of patients. In group 2, an excellent result was obtained in 59.3% of patients, good – in 33.4% and satisfactory – in 7.3% of cases. In group 1, 15 (32.7%) patients were diagnosed with 26 complications, and in group 2 – 5 (16.6%) patients with 5 complications.Conclusions. The use of the developed surgical technique and the original fixator made it possible to increase the percentage of excellent and good treatment results from 84.5% to 92.7% and to reduce the number of complications associated with OWHTO from 32.7% to 16.6%.

остеоартритколенный суставоткрывающая угол высокая тибиальная остеотомияосложненияхирургическая техникамодульный спейсероригинальный фиксаторosteoarthritisknee jointopen wedge high tibial osteotomycomplicationssurgery techniquemodular spaceroriginal fixatorReferencesSchuster P. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med. 2018;46(6):1362-1370. doi: 10.1177/0363546518758016Schuster P. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med. 2018;46(6):1362-1370. doi: 10.1177/0363546518758016Darees M. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years’ follow-up. Orthop Traumatol Surg Res. 2018;104(4):477-480. doi: 10.1016/j.otsr.2017.12.021Darees M. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years’ follow-up. Orthop Traumatol Surg Res. 2018;104(4):477-480. doi: 10.1016/j.otsr.2017.12.021Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):948-954. doi: 10.1007/s00167-006-0074-1Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):948-954. doi: 10.1007/s00167-006-0074-1Dexel J, Fritzsche H, Beyer F, Harman MK, Lützner J. Openwedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):832-837. doi: 10.1007/s00167-015-3730-5Dexel J, Fritzsche H, Beyer F, Harman MK, Lützner J. Openwedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):832-837. doi: 10.1007/s00167-015-3730-5Schröter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy. 2011;27(5):644-652. doi: 10.1016/j.arthro.2011.01.008Schröter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy. 2011;27(5):644-652. doi: 10.1016/j.arthro.2011.01.008van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA. Opposite cortical fracture in high tibial osteotomy: Lateral closing compared to the medial opening-wedge technique. Acta Orthop. 2008;79(4):508-514. doi: 10.1080/17453670710015508van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA. Opposite cortical fracture in high tibial osteotomy: Lateral closing compared to the medial opening-wedge technique. Acta Orthop. 2008;79(4):508-514. doi: 10.1080/17453670710015508Ogawa H, Matsumoto K, Akiyama H. The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: A case control study. Knee. 2017;99-B(7). doi: 10.1302/0301-620X.99B7.BJJ-2016-0927.R1Ogawa H, Matsumoto K, Akiyama H. The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: A case control study. Knee. 2017;99-B(7). doi: 10.1302/0301-620X.99B7.BJJ-2016-0927.R1Cotic M, Vogt S, Hinterwimmer S, Feucht MJ, Slotta-Huspenina J, Schuster T, et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: Peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2032-2040. doi: 10.1007/s00167-014-2914-8Cotic M, Vogt S, Hinterwimmer S, Feucht MJ, Slotta-Huspenina J, Schuster T, et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: Peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2032-2040. doi: 10.1007/s00167-014-2914-8Cotic M, Vogt S, Feucht MJ, Saier T, Minzlaff P, Hinterwimmer S, et al. Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3707-3716. doi: 10.1007/s00167-014-3287-8Cotic M, Vogt S, Feucht MJ, Saier T, Minzlaff P, Hinterwimmer S, et al. Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3707-3716. doi: 10.1007/s00167-014-3287-8Song EK, Seon JK, Park SJ, Jeong MS. The complications of high tibial osteotomy closing- versus opening-wedge methods. J Bone Joint Surg Br. 2010;92-B(9):1245-1252. doi: 10.1302/0301-620X.92B9.23660Song EK, Seon JK, Park SJ, Jeong MS. The complications of high tibial osteotomy closing- versus opening-wedge methods. J Bone Joint Surg Br. 2010;92-B(9):1245-1252. doi: 10.1302/0301-620X.92B9.23660Miller BS, Downie B, McDonough B, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy. 2009;25(6):639-646. doi: 10.1016/j.arthro.2008.12.020Miller BS, Downie B, McDonough B, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy. 2009;25(6):639-646. doi: 10.1016/j.arthro.2008.12.020Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94. doi: 10.1016/j.arthro.2011.06.034Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94. doi: 10.1016/j.arthro.2011.06.034Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg. 2003;124:649-653. doi: 10.1007/s00402-003-0588-7Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg. 2003;124:649-653. doi: 10.1007/s00402-003-0588-7Nelissen EM, van Langelaan EJ, Nelissen RGHH. Stability of medial opening wedge high tibial osteotomy: A failure analysis. Int Orthop. 2010;34:217-223. doi: 10.1007/s00264-009-0723-3.Nelissen EM, van Langelaan EJ, Nelissen RGHH. Stability of medial opening wedge high tibial osteotomy: A failure analysis. Int Orthop. 2010;34:217-223. doi: 10.1007/s00264-009-0723-3.Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy. 2010;26(12):1607-1616. doi: 10.1016/j.arthro.2010.05.006Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy. 2010;26(12):1607-1616. doi: 10.1016/j.arthro.2010.05.006Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg (Br). 2006;88(11):1454-1459. doi: 10.1302/0301-620X.88B11.17743Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg (Br). 2006;88(11):1454-1459. doi: 10.1302/0301-620X.88B11.17743Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH. Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy. 2013;29(6):1063-1071. doi: 10.1016/j.arthro.2013.02.020Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH. Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy. 2013;29(6):1063-1071. doi: 10.1016/j.arthro.2013.02.020Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: Prognostic factors. Am J Sports Med. 2014;42(3):690-698. doi: 10.1177/0363546513516577Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: Prognostic factors. Am J Sports Med. 2014;42(3):690-698. doi: 10.1177/0363546513516577Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc. 2011;19(3):333-339. doi: 10.1007/s00167-010-1335-6Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc. 2011;19(3):333-339. doi: 10.1007/s00167-010-1335-6Yacobucci GN, Cocking MR. Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft. Am J Sports Med. 2008;36(4):713-719. doi: 10.1177/0363546507312646Yacobucci GN, Cocking MR. Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft. Am J Sports Med. 2008;36(4):713-719. doi: 10.1177/0363546507312646Roberson TA, Momaya AM, Adams K, Long CD, Tokish JM, Wyland DJ. High tibial osteotomy performed with all-PEEK implants demonstrates similar outcomes but less hardware removal at minimum 2-year follow-up compared with metal plates. Orthop J Sports Med. 2018;6(3):2325967117749584. doi: 10.1177/2325967117749584Roberson TA, Momaya AM, Adams K, Long CD, Tokish JM, Wyland DJ. High tibial osteotomy performed with all-PEEK implants demonstrates similar outcomes but less hardware removal at minimum 2-year follow-up compared with metal plates. Orthop J Sports Med. 2018;6(3):2325967117749584. doi: 10.1177/2325967117749584Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, et al. Complications associated with opening wedge high tibial osteotomy – A review of the literature and of 15 years of experience. Knee. 2016;23(2):276-282. doi: 10.1016/j.knee.2015.09.018Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, et al. Complications associated with opening wedge high tibial osteotomy – A review of the literature and of 15 years of experience. Knee. 2016;23(2):276-282. doi: 10.1016/j.knee.2015.09.018Lash NJ, Feller JA, Batty LM, Wasiak J, Richmond AK. Bone grafts and bone substitutes for opening-wedge osteotomies of the knee: A systematic review. Arthroscopy. 2015;31(4):720-730. doi: 10.1016/j.arthro.2014.09.011Lash NJ, Feller JA, Batty LM, Wasiak J, Richmond AK. Bone grafts and bone substitutes for opening-wedge osteotomies of the knee: A systematic review. Arthroscopy. 2015;31(4):720-730. doi: 10.1016/j.arthro.2014.09.011Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11:132-138. doi: 10.1007/s00167-002-0334-7Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11:132-138. doi: 10.1007/s00167-002-0334-7Valkering KP, van den Bekerom MPJ, Kappelhoff FM, Albers GHR. Complications after TomoFix medial opening wedge high tibial osteotomy. J Knee Surg. 2009;22(3):218-225.Valkering KP, van den Bekerom MPJ, Kappelhoff FM, Albers GHR. Complications after TomoFix medial opening wedge high tibial osteotomy. J Knee Surg. 2009;22(3):218-225.Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Lee IS. Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res. 2016;28(4):289-296. doi: 10.5792/ksrr.16.028Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Lee IS. Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res. 2016;28(4):289-296. doi: 10.5792/ksrr.16.028Bialik VE, Makarov SA, Bialik EI, Nesterenko VA, Nurmukhametov MR. Complications of open wedge high tibial osteotomy. Analysis of the causes of complications and ways to eliminate them. Nauchcno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2021;59(2):215-224 (In Russ.). doi: 10.47360/1995-4484-2021-215-224Bialik VE, Makarov SA, Bialik EI, Nesterenko VA, Nurmukhametov MR. Complications of open wedge high tibial osteotomy. Analysis of the causes of complications and ways to eliminate them. Nauchcno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2021;59(2):215-224 (In Russ.). doi: 10.47360/1995-4484-2021-215-224Barashkov VN, Smolina IYu, Puteeva LE, Pestsov DN. Fundamentals of the theory of elasticity: Tutorial. Tomsk;2012:184 (In Russ.).Barashkov VN, Smolina IYu, Puteeva LE, Pestsov DN. Fundamentals of the theory of elasticity: Tutorial. Tomsk;2012:184 (In Russ.).Feodosiev VI. Resistance of materials: textbook for universities; 16th ed. Moscow; 2016:543 (In Russ.).Feodosiev VI. Resistance of materials: textbook for universities; 16th ed. Moscow; 2016:543 (In Russ.).Kim KI, Kim GB, Kim HJ, Lee SH, Yoon WK. Extra-articular lateral hinge fracture does not affect the outcomes in medial openwedge high tibial osteotomy using a locked plate system. Arthroscopy. 2018;34(12):3246-3255. doi: 10.1016/j.arthro.2018.07.022Kim KI, Kim GB, Kim HJ, Lee SH, Yoon WK. Extra-articular lateral hinge fracture does not affect the outcomes in medial openwedge high tibial osteotomy using a locked plate system. Arthroscopy. 2018;34(12):3246-3255. doi: 10.1016/j.arthro.2018.07.022Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Nakanishi A, Inoue D, et al. Large opening gaps, unstable hinge fractures, and osteotomy line below the safe zone cause delayed bone healing after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1291-1298. doi: 10.1007/s00167-018-5334-3Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Nakanishi A, Inoue D, et al. Large opening gaps, unstable hinge fractures, and osteotomy line below the safe zone cause delayed bone healing after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1291-1298. doi: 10.1007/s00167-018-5334-3

The authors declare that there are no conflicts of interest present.