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Outcomes of concurrent bilateral medial opening wedge high tibial o
ESSKA Academy. Cross C. May 9, 2018; 212525; P11-1693
Ms. Charlotte Cross
Ms. Charlotte Cross
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Abstract
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Objectives: Medial opening wedge high tibial osteotomy (HTO) is an established treatment for isolated medial compartment knee osteoarthritis, shifting the weight to the well preserved lateral compartment. Patients frequently present with bilateral disease. There is plethora of literature highlighting the success of bilateral total knee replacements, however there is dearth of evidence regarding single setting, bilateral high tibial osteotomies. To our knowledge this is the largest series that describes the process and outcome of a cohort of patients who underwent concurrent bilateral medial opening wedge high tibial osteotomy.

Methods: 20 patients (40 knees) with symptomatic bilateral isolated medial compartment osteoarthritis underwent concurrent bilateral HTO between December 2012 and June 2016.
All patients had a pre-operative MRI to confirm integrity of the lateral compartment articular cartilage. Calibrated, patella centred, standing long leg alignment films were used to plan correction angle and opening wedge distance on the picture archiving and communication system, using the Miniacci planning method. The intended correction was patient specific and determined by the senior surgeon. The accuracy of correction was calculated as the difference between the intended and the actual correction of the Mikulicz point in a limb alignment view 1 year post-operatively.
The high tibial osteotomy was performed using angle stable plate fixation by the senior surgeon or the fellow under supervision. All patients received an enhanced recovery protocol and 2 weeks of VTE prophylaxis. Post operatively patients were kept non-weight bearing for 2 weeks followed by 4 weeks of protected weight bearing. Full weight bearing was commenced at 6 to 8 weeks.

Results: Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), showed improvement at one year. Correction accuracy in 17 knees was within 5 % ,8 within 10% and 15 knees within 20 % of the planned correction. One patient had revision to Bilateral knee replacements.

Conclusions: Single setting bilateral high tibial osteotomies delivers comparable results in terms of accuracy and clinical outcome when compared to staged surgery. It brings the added benefit of shorter overall recovery time for patients and delivers cost savings for providers.

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