Management of knee osteoarthritis using percutaneous high tibial osteotomy for correction of genu varum deformity in adolescents and young adults

Background

Genu varum is not uncommon among young adults and adolescents and may increase the risk of knee osteoarthritis (OA).

Aim of the work

To analyse the ability to correct and achieve osseous union of genu varum with high tibial osteotomy (HTO) using a dynamic axial fixator (DAF) and to evaluate knee function and pain.

Patients and methods

Fifteen knees in 13 patients with genu varus and medial compartment knee pain underwent open wedge HTO using DAF. Clinical evaluation was done using Modified Lysholm score and new Knee Society score (KSS). Long-standing X-rays were performed.

Results

The mean age of the patients was 21.9 ± 2.57 years (18–28 years) and they were 8 males and 5 females. The mean medial proximal tibial angle (MPTA) improved from 78.9 ± 4.35 (69–84) pre-operative to 91.7 ± 2.37 (88–96) post-operative. The mean mechanical tibiofemoral angle (mTFA) improved from 168.5 ± 4.06 (160–176) pre-operative to 180.4 ± 3.11 (176–186) post-operative. The target correction was achieved in 12 knees (80%) and under-correction occurred in three (20%). Significant post-operative improvements in pain and function of daily life were seen. All osteotomies healed before 4 months. The mean Modified Lyshlom and KSS scores improved from 66.4 ± 24.02 and 135.1 ± 43.95 preoperatively to 95.5 ± 9.51 and 236.9 ± 11.38 respectively (p < 0.0001 both). 6/15 (40%) knees showed complications in the form of superficial pin tract infection that all resolved without any sequela.

Conclusion

For the treatment of proximal tibia vara, HTO with DAF was safe and effective, allowing for correct post-operative alignment modification with high union rates and trivial sequelae.