Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: A comparative prospective multicenter study

Introduction: Valgus high tibial osteotomy is considered to be an effective treatment for uni-compartmental medial osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. However, the effects on posterior tibial slope of closing- or opening-wedge osteotomies remain controversial. Hypothesis: We analyzed the modifications of tibial slope after opening- and closing- wedge high tibial osteotomies and compared the results of these two procedures. We hypothesized that there was no difference in postoperative tibial slope between opening and closing- wedge osteotomies. Patients and methods: This prospective consecutive nonrandomized multicenter study was conducted between January 2008 and March 2009 and included 321 patients: 205 men and 116 women. A total of 224 patients underwent an opening-wedge high tibial osteotomy and 97 a closing-wedge osteotomy. The mean age was 52 years +/- 9 and the mean body mass index was 28 kg/m(2) +/- 5. The main etiology was primary arthritis. Posterior tibial slope was measured preoperatively and at the last follow-up on a lateral radiograph in relation to the posterior tibial cortex. Results: In the opening-wedge group, a definite 0.6 degrees increase in tibial slope (P = 0.016) was observed. In the closing-wedge group, a definite 0.7 degrees decrease in tibial slope (P = 0.02) was found. Fourteen percent of the opening-wedge osteotomies increased tibial slope by 5. or more versus only 2% of the closed-wedge osteotomies (P < 0.001). Twelve percent of the closing-wedge high tibial osteotomies led to a decrease of 5 degrees or more of the tibial slope versus 7% of the opening-wedge osteotomies (P < 0.02). Discussion and conclusion: These results confirm what is generally reported in the literature, i.e., an increase in tibial slope in opening-wedge high tibial osteotomy and a decrease in the slope in closing-wedge osteotomies. These tibial slope changes appear to be very limited in this series, less than 1 degrees on average. However, there was a bias since the open-wedge technique was preferred in cases with substantial varus deformity. We emphasize the importance of surgical technique to avoid alteration of the tibial slope, particularly in opening-wedge high tibial osteotomy for which we recommend a release of posterior soft tissue and a complete osteotomy of the posterior cortex of the tibia. Level of evidence: III. Prospective consecutive nonrandomized multicenter study. (C) 2011 Elsevier Masson SAS. All rights reserved.