Results of open wedge high tibial osteotomy using plate osteosynthesis (Tomofix) without grafting

Primary osteoarthritis (OA) most commonly involves medial compartment of the knee. High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthrosis. The aim of our study was to assess the early results of medial open wedge osteotomy in medial uni-compartment OAfixed with locking plate. Between June 2013 and August 2015, twenty patients, 6 males and 14 females with mean age of 50.3±10.99 years, suffering from medial unicompartmental osteoarthritis of knee joint were operated for medial open wedge high tibial osteotomy. All the patients were analysed for preoperative and postoperative grade of OA (Kellgren Lawrence grading), mean body mass index, visual analogue score, Knee injury and osteoarthritis outcome score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Mean VAS decreased significantly postoperatively to 1.4±0.50 from 7.2±1.0 (p <0.001). Mean walking distance increased significantly to 1174±161.81 from 590±91.19 meters preoperatively (p <0.001). In the present study WOMAC (pain) score was 3.11±0.43 preoperatively while postoperatively it was 0.77±0.29 (p<0.001). WOMAC (stiffness) score preoperatively was 3.27±0.30 while at final follow up it was 0.95±0.39 (p<0.001). WOMAC score (global function) was 2.92±0.44 preoperatively and at final follow up it was 0.69±0.14 (p<0.001). WOMAC score (total, average and index) was 75.94±9.46 preoperatively and 18.60±3.38 postoperatively (p<0.001). KOOS score regarding pain; ADL, SR, quality of life and total was 114±7.55 preoperatively and 37.6±8.14 postoperatively with significant difference (p <0.001). KOOS index was 157±19.78 preoperatively and 370.43±30.26 postoperatively with significant difference (p <0.001). All the patients were evaluated at the end of study regarding their experience and they were further graded according to their satisfaction. A total of 12(60%) reported the procedure as excellent; 6(30%) much better and 2 (10%) little better. The average postoperative tibio-femoral angle was 4 degree valgus. Complications observed were leg swelling in 7; infection in 2 and LPN in 1. Medial opening HTO fixed with a locking plate is a physiologically better surgery in medial compartment primary OA of knee in early stages. The procedure is a very good alternative to unicompartmental/total knee arthroplasty in our scenario where patient is reluctant to change theirsquatting habits and job profile. Early results are very gratifying.