High tibial osteotomy: a seven-year clinical and radiographic follow-up.

A series of 107 knees were evaluated for mobility, stability and pain relief two and seven years after high tibial osteotomy for correction of deformity secondary to arthrosis; patients with rheumatoid arthritis were excluded from this series. Eighteen knees had lateral femorotibial arthrosis, or which only six had good results at seven year follow-up. As many as six knees required further surgery. Of the 89 knees with medial arthrosis, 45 had good results, 36 did not and the remaining eight required further surgery. Lasting pain relief was clearly associated with correction of the mechanical axis of the knee which was more difficult to achieve in severe stages of the disease. In 22 of the 24 corrected knees, the disease had not progressed further. Six of these showed radiographic signs of cartilage repair. By contrast, two-thirds of the undercorrected knees had further progress of the disease. The opposite compartment did not suffer from the increased load on the articular cartilage; only three overcorrected knees showed cartilage narrowing, and they were painless. High tibial osteotomy is a reliable method for definitive treatment of early medial type gonarthrosis provided that the radiographically defined mechanical axis is adequately corrected.