International Orthopaedics

, Volume 43, Issue 6, pp 1379–1386 | Cite as

Medial open wedge vs. lateral closed wedge high tibial osteotomy - Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases

  • Felix FernerEmail author
  • Christoph Lutter
  • Joerg Dickschas
  • Wolf Strecker
Original Paper



Medial open wedge (MOW) and lateral closed wedge (LCW) osteotomies are established methods to treat medial gonarthritis. Advantages and differences in the outcome of the two techniques have been discussed controversially and there is still no precise recommendation for either technique. We now aimed to assess the effect of each technique on tibial slope (TS), patella height (PH) and leg length discrepancy.


In a study of 50 consecutive cases of MOW and 50 of LCW osteotomies were registered. The decision for either technique was made pre-operatively according to an algorithm. Demographic data, operation procedures (time of operation, correction angle, torsional correction) and measurement of patellar height, tibial slope, leg length discrepancy, clinical outcome after one year and bone and wound healing were obtained. Pre- and post-operative values were compared between the two groups.


In absence of randomization demographic data demonstrate comparability of the two groups. No difference in bone and wound healing, time of operation and clinical outcome was seen. In the MOW group PH decreased significantly, no relevant alteration of PH was detected in the LCW group. In the latter group a statistically significant decrease of TS compared to a slightly decrease in the MOW group was recorded post-operatively. A significant leg lengthening with the MOW and shortening of the leg with the LCW method can be achieved.


With respect to similar results in operating procedures, bone and wound healing and clinical outcome decision making factors for either technique should be leg length discrepancy and torsional deformities. Changes of PH and TS have to be known and may influence the technique of osteotomy in cases of patella infera / alta or borderline PH.


An algorithm for valgus high tibial osteotomies based on TS, PH and leg length discrepancy may be proposed.


Gonarthritis Osteotomy Varus deformity Surgical technique 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    De Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. Injury 34(Suppl 2):B55–B62CrossRefGoogle Scholar
  2. 2.
    Schroter S, Lobenhoffer P, Mueller J, Ihle C, Stockle U, Albrecht D (2012) Changes of patella position after closed and open wedge high tibial osteotomy: review of the literature. Der Orthopade 41:186:188–194CrossRefGoogle Scholar
  3. 3.
    Smith TO, Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368. CrossRefGoogle Scholar
  4. 4.
    El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38:323–329. CrossRefGoogle Scholar
  5. 5.
    Waidelich HA, Strecker W, Schneider E (1992) Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo 157:245–251. CrossRefGoogle Scholar
  6. 6.
    Strecker W, Keppler P, Gebhard F, Kinzl L (1997) Length and torsion of the lower limb. J Bone and Joint Surg Br 79:1019–1023CrossRefGoogle Scholar
  7. 7.
    Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone and Joint Surg Br 59:241–242CrossRefGoogle Scholar
  8. 8.
    Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68:317–325Google Scholar
  9. 9.
    Galla M, Lobenhoffer P (2004) Die öffnende valgisierende Umstellungsosteotomie der proximalen Tibia mit dem Tomofix-Plattenfixateur. Oper Orthop Traumatol 16:397–417Google Scholar
  10. 10.
    Strecker W, Muller M, Urschel C (2014) High tibial closed wedge valgus osteotomy. Oper Orthop Traumatol 26:196–205. CrossRefGoogle Scholar
  11. 11.
    Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465Google Scholar
  12. 12.
    Hinterwimmer S, Feucht MJ, Paul J, Kirchhoff C, Sauerschnig M, Imhoff AB, Beitzel K (2016) Analysis of the effects of high tibial osteotomy on tibial rotation. Int Orthop 40:1849–1854. CrossRefGoogle Scholar
  13. 13.
    Portner O (2014) High tibial valgus osteotomy: closing, opening or combined? Patellar height as a determining factor. Clin Orthop Relat Res 472:3432–3440. CrossRefGoogle Scholar
  14. 14.
    Tigani D, Ferrari D, Trentani P, Barbanti-Brodano G, Trentani F (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334CrossRefGoogle Scholar
  15. 15.
    Portner O, Pakzad H (2011) The evaluation of patellar height: a simple method. J Bone Joint Surg Am 93:73–80. CrossRefGoogle Scholar
  16. 16.
    Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984. CrossRefGoogle Scholar
  17. 17.
    Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone and Joint Surg Br 87:1227–1232. CrossRefGoogle Scholar
  18. 18.
    Hohmann E, Bryant A, Imhoff AB (2006) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc 14:454–459. CrossRefGoogle Scholar
  19. 19.
    El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone and Joint Surg Br 90:1193–1197. CrossRefGoogle Scholar
  20. 20.
    Na YG, Eom SH, Kim SJ, Chang MJ, Kim TK (2016) The use of navigation in medial opening wedge high tibial osteotomy can improve tibial slope maintenance and reduce radiation exposure. Int Orthop 40:499–507. CrossRefGoogle Scholar
  21. 21.
    Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34:305–309. CrossRefGoogle Scholar
  22. 22.
    Bastos Filho R, Magnussen RA, Duthon V, Demey G, Servien E, Granjeiro JM, Neyret P (2013) Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy. Int Orthop 37:427–431. CrossRefGoogle Scholar
  23. 23.
    Wang JH, Shin JM, Kim HH, Kang SH, Lee BH (2017) Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy. Int Orthop 41:85–92. CrossRefGoogle Scholar
  24. 24.
    Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone and Joint Surg Br 88:1454–1459. CrossRefGoogle Scholar
  25. 25.
    Magnussen RA, Lustig S, Demey G, Neyret P, Servien E (2011) The effect of medial opening and lateral closing high tibial osteotomy on leg length. Am J Sports Med 39:1900–1905. CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Felix Ferner
    • 1
    Email author
  • Christoph Lutter
    • 1
  • Joerg Dickschas
    • 1
  • Wolf Strecker
    • 1
  1. 1.Klinik Orthopädie und Unfallchirurgie BambergBambergGermany

Personalised recommendations