High tibial valgus osteotomy. A clinical review.

Thirty-one consecutive high tibial valgus osteotomies for varus gonarthrosis performed by one surgeon using one technique were evaluated to determine correction of deformity, functional result, subjective impression, and subsequent surgery for the same problem. Twenty-five patients had satisfactory follow-up evaluations. Preoperative tibiofemoral angulation averaged 7 degrees varus. Postoperative tibiofemoral angulation averaged 5 degrees valgus. Ninety-two percent had excellent or good results, according to Coventry's criteria and the H.S.S. knee score. Eighty-eight percent claimed postoperative improvement, 8% were unchanged, and one patient was worse. Eighty-eight percent had had no further surgery. Excellent/good results deteriorated from 92% at two years to 88% at five years, to 91% at seven years, and to 80% at nine years. This is a smaller rate of deterioration than noted in other series. Analgesic and antiinflammatory drug use was significantly reduced after operation. No significant differences were noted in patients older than or younger than 60 years of age at the time of surgical correction. Factors contributing to success included careful patient selection; correction of the limb to the mechanical axis; and precise surgical technique. Osteotomy proved a successful alternative to total knee replacement for treatment of varus gonarthrosis in a carefully selected group of patients.