The Oxford hip and knee scores have been extensively used since they were first described in 1996 and 1998. During this time, they have been modified and used for many different purposes. This paper describes how they should be used and seeks to clarify areas of confusion.

The use of the Oxford hip and knee scores

High Tibial Osteotomy (HTO) is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. The classic procedure for correcting varus deformity is the lateral closed wedge osteotomy of the tibia with osteotomy of the fibula. The disadvantages of this technique are well known. Open wedge osteotomy from the medial side eliminates the risk of compartment syndrome and peroneal nerve injuries. A new fixation device (TomoFix) with an adapted surgical technique allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts. In a prospective study, 92 consecutive cases were treated with this procedure. Bony healing with remodelling of the medial and posterior cortical bone was observed. Full weight-bearing was possible ten weeks after surgery. There were no implant failures. Complications included one delayed union, two revarisations and one deep infection.

TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases.

Purpose The purpose of this study was to investigate complications of the medial opening wedge high tibial osteotomy (HTO) procedure at our institution. Methods All cases of medial opening wedge HTO performed between 2001 and 2004 at our institution were identified. Medical records, operative reports, and radiographs were retrospectively reviewed for all patients who experienced a complication within 12 months postsurgery. All complications were identified for analysis. Results Forty-six patients were included in this study; 17 (36.9%) patients had a documented complication. There were 7 patients (15.2%) with loss of correction, 2 (4.3%) with intraoperative lateral cortex fractures, 2 (4.3%) with postoperative lateral cortex fractures, 2 (4.3%) with deep venous thrombosis, 2 (4.3%) with delayed unions, and 2 (4.3%) with symptomatic hardware. Patients with a loss of angular correction had a greater body mass index (BMI) than those without a loss of correction (mean BMI, 32.5 v 28.8; P = .0416). Of the 7 patients with loss of angular correction, 6 had a first-generation fixation device and 1 had a second-generation device. There was no apparent association between delayed union and graft type (allograft v autograft). Conclusions The medial opening wedge HTO is associated with a moderate frequency of complications. The frequency and type of complications seem to be similar to those reported for the lateral closing technique. Although there are technical advantages offered by the medial opening wedge HTO, their influence on the frequency and type of complications experienced by patients in our series was not apparent. Level of Evidence Level IV, case series.

Complications After Medial Opening Wedge High Tibial Osteotomy

BackgroundHigh tibial osteotomy has been associated with significant complications, including delayed union or nonunion, loss of correction, arthrofibrosis, and patella infera.HypothesesA technique for opening wedge osteotomy that incorporates an autogenous iliac crest bone graft will prevent delayed union or nonunion, allow early rehabilitation and weightbearing, and prevent knee arthrofibrosis and patella infera. Secondly, the authors’ methods for calculating the desired correction of valgus alignment prevent undesired alterations in tibial slope.Study DesignCase series; Level of evidence, 4.MethodsA total of 55 consecutive patients who underwent high tibial osteotomy were observed at a mean of 20 months postoperatively. Preoperative and postoperative measurements of radiographs were conducted by independent examiners for bony union, tibial slope, and patellar height. The osteotomy opening size ranged from 5 to 17.5 mm; 35 knees (64%) had openings [.lessequal]10 mm, and 20 knees (36%) had openings >11 m...

Opening Wedge High Tibial Osteotomy An Operative Technique and Rehabilitation Program to Decrease Complications and Promote Early Union and Function

Background:Medial opening wedge high tibial osteotomy (OWHTO) is a widely accepted procedure for the treatment of medial compartment arthritis of the knee. Compared with closing wedge HTO, however, the outcomes of OWHTO reported in the literature are incomplete.Purpose:To identify the positive and negative prognostic factors related to the outcomes of OWHTO through an evaluation of midterm study results and survivorship analysis.Study Design:Case series; Level of evidence, 4.Methods:From January 2001 to December 2009, a total of 141 consecutive OWHTOs were performed in 123 patients. Only patients with symptomatic medial knee overload/arthritis were included. The patients were evaluated preoperatively and at every follow-up visit with (1) the Knee Society score, (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. Preoperative, intraoperative, and postoperative variables were investigate...

Medial Opening Wedge High Tibial Osteotomy for Medial Compartment Overload/Arthritis in the Varus Knee: Prognostic Factors

High tibial osteotomy is an accepted treatment for unicompartmental osteoarthritis of the knee. Conventional osteotomy can be a demanding procedure with potential for complications. Opening wedge high tibial osteotomy using an external fixator is an alternative that may have advantages in comparison with classic methods. The aims of the current study were to determine if opening wedge osteotomy using hemicallotasis techniques is safer than, and the outcome comparable with that of, conventional techniques. Seventy-six high tibial osteotomies were performed in 65 patients for primary osteoarthritis. The mean age of the patients was 54.8 years (range, 36-70 years). The mean followup was 6 years. The only serious complication occurred in one patient, who had chronic osteomyelitis develop 2 years after surgery. There were no neurologic or vascular complications. The authors think this technique is safer than conventional techniques. Survivorship at 5 and 10 years was 89% and 63%, respectively. The mean knee score in osteotomies was 26.6 (maximum possible score, 48). The outcome is comparable with, or better than, that of other techniques for osteotomy. Subsequent knee replacement, in cases requiring conversion, was straightforward. The mean score in knees that had osteotomies that were converted to total knee replacements was 33.7.

High tibial osteotomy using a dynamic axial external fixator.

The aim of this retrospective study was to examine a cohort of patients who had undergone high tibial osteotomy (HTO) using the method of opening wedge hemicallotasis, and who later required conversion to total knee replacement (TKR). The incidence of patella infra and any technical difficulties encountered during TKR operation were examined. A consecutive series of 76 valgus osteotomies in 65 patients were carried out by one surgeon using a dynamic axial fixator (DAF). Later conversion to TKR, required for the progression of symptoms, was carried out in nine knees (seven patients) at a mean time from the initial osteotomy of 7 years (1.5–11). All of those patients who underwent HTO and subsequently required conversion to TKR were followed up. The patellar height was assessed by one observer in all knees pre- and post-HTO using the Insall and Salvati [6] and Blackburne and Peel [1] ratios. Using these criteria, only one case of patella infra occurred. There were no added technical difficulties in performing TKR as a result of the previous osteotomy and clinical outcomes using the Oxford knee score were satisfactory (34 where 48 is maximum).

Patellar tendon length following opening wedge high tibial osteotomy using an external fixator with particular reference to later total knee replacement.

A.S. Lee

Papers

High tibial osteotomy using a dynamic axial external fixator.

Patellar tendon length following opening wedge high tibial osteotomy using an external fixator with particular reference to later total knee replacement.