Download PDF
J Knee Surg 2022; 35(08): 916-921
DOI: 10.1055/s-0040-1721090
Original Article

High Tibial Osteotomy with a Modern Polyetheretherketone (PEEK) System: Mid-Term Results at a Mean of 6 Years Follow-Up

Lucas K. Keyt
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Mario Hevesi
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Bruce A. Levy
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Aaron J. Krych
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Christopher L. Camp
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Michael J. Stuart 
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The purpose of this study was to determine patient-reported outcomes, hardware removal rates, as well as conversion to arthroplasty at mid-term follow-up following high tibial osteotomy (HTO) with a modern polyetheretherketone (PEEK) system. All PEEK system-based HTOs performed at a single institution between January 2010 and January 2016 with a minimum of 2 years follow-up were reviewed. Rates of postoperative complications, hardware removal and conversion to arthroplasty were calculated. Patient-reported outcomes including visual analog pain scale (VAS), Tegner activity scale, Lysholm, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 36-Item Short Form Survey (SF-36) were obtained. Forty-seven HTOs in 43 patients (mean age: 37.6 ± 10.8 years; 30 M, 13 F) were followed for a mean of 6.0 ± 1.5 years. A total of four postoperative complications occurred in three patients, resulting in an overall complication rate of 6.4%. Hardware removal occurred in three patients at a mean of 0.73 ± 0.53 years after surgery, with overall survival free of hardware removal of 96% (95% confidence interval [CI]: 85–99) at 1 year, 94% (95% CI: 82–98) at 2 years, and 94% (95% CI: 82–98) at 8 years. Conversion to arthroplasty occurred in three patients at a mean of 3.2 ± 1.0 years after surgery, with mean survival of 100% (95% CI: 94–100) at 1 year, 100% (95% CI: 94–100) at 2 years, and 93% (95% CI: 81–98) at 8 years. VAS at rest improved, from 3.1 ± 2.5 preoperatively to 1.1 ± 1.6 postoperatively (p < 0.001). Patients remained active, with a mean Tegner activity scale of 4.4 ± 1.4 at final follow-up and satisfactory Lysholm, KOOS, and SF-36 scores. At mid-term follow-up, medial opening-wedge HTO using a modern PEEK-based system was found to be safe, efficacious, and durable, with satisfactory outcome scores and a low rate of conversion to arthroplasty. PEEK-based implants were found to have low hardware removal rates of 6% at 5 years, which compares favorably to historic metal fixation. This is a Level III study.

Keywords

high tibial osteotomy - polyetheretherketone - hardware removal rates - complication rate - KOOS - Tegner activity score - SF-36 score


Publication History

Received: 06 July 2020

Accepted: 05 October 2020

Article published online:
23 November 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 2011; 19 (10) 590-599
    CrossrefPubMedGoogle Scholar
  • 2 Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High tibial osteotomy. J Am Acad Orthop Surg 2005; 13 (04) 279-289
    CrossrefPubMedGoogle Scholar
  • 3 Loia MC, Vanni S, Rosso F. et al. High tibial osteotomy in varus knees: indications and limits. Joints 2016; 4 (02) 98-110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Debeyre J, Artigou JM. [Long term results of 260 tibial osteotomies for frontal deviations of the knee]. Rev Chir Orthop Repar Appar Mot 1972; 58 (04) 335-339
    PubMedGoogle Scholar
  • 5 Debeyre J, Patte D. [Value of corrective osteotomies in the treatment of certain knee diseases with axial deviation]. Rev Rhum Mal Osteoartic 1962; 29: 722-729
    PubMedGoogle Scholar
  • 6 Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 2006; 14 (10) 948-954
    CrossrefPubMedGoogle Scholar
  • 7 Gaasbeek RD, Nicolaas L, Rijnberg WJ, van Loon CJ, van Kampen A. Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study. Int Orthop 2010; 34 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 8 Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 2004; 124 (10) 649-653
    CrossrefPubMedGoogle Scholar
  • 9 Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G. The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg 2005; 125 (09) 638-643
    CrossrefPubMedGoogle Scholar
  • 10 Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 2010; 26 (12) 1607-1616
    CrossrefPubMedGoogle Scholar
  • 11 Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. 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 Joint Surg Br 2006; 88 (11) 1454-1459
    CrossrefPubMedGoogle Scholar
  • 12 Hevesi M, Macalena JA, Wu IT. et al. High tibial osteotomy with modern PEEK implants is safe and leads to lower hardware removal rates when compared to conventional metal fixation: a multi-center comparison study. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1280-1290
    CrossrefPubMedGoogle Scholar
  • 13 Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 2007; 28 (32) 4845-4869
    CrossrefPubMedGoogle Scholar
  • 14 Blackman AJ, Krych AJ, Engasser WM, Levy BA, Stuart MJ. Does proximal tibial osteotomy with a novel osteotomy system obtain coronal plane correction without affecting tibial slope and patellar height?. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3487-3493
    CrossrefPubMedGoogle Scholar
  • 15 Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985; 5 (04) 145-148
    CrossrefPubMedGoogle Scholar
  • 16 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 17 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10 (03) 150-154
    CrossrefPubMedGoogle Scholar
  • 18 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
    Google Scholar
  • 19 Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ 1993; 2 (03) 217-227
    CrossrefPubMedGoogle Scholar
  • 20 Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop 2010; 34 (02) 155-160
    CrossrefPubMedGoogle Scholar
  • 21 Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR. Return to work and sport following high tibial osteotomy: a systematic review. J Bone Joint Surg Am 2016; 98 (18) 1568-1577
    CrossrefPubMedGoogle Scholar
  • 22 Thompson KA, Darden CN, Katsman A, Alaia MJ, Strauss EJ, Jazrawi LM. Short-term clinical outcomes of high tibial osteotomy with the iBalance HTO system. Bull Hosp Jt Dis (2013) 2019; 77 (04) 256-262
    PubMedGoogle Scholar
  • 23 Getgood A, Collins B, Slynarski K. et al. Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 260-269
    CrossrefPubMedGoogle Scholar
  • 24 Roberson TA, Momaya AM, Adams K, Long CD, Tokish JM, Wyland DJ. High tibial osteotomy performed with all-PEEK implants demonstrates similar outcomes but less hardware removal at minimum 2-year follow-up compared with metal plates. Orthop J Sports Med 2018; 6 (03) 2325967117749584
    CrossrefPubMedGoogle Scholar
  • 25 Ghinelli D, Parma A, Baldassarri M. et al. High tibial osteotomy for the treatment of medial osteoarthritis of the knee with new iBalance system: 2 years of follow-up. Eur J Orthop Surg Traumatol 2016; 26 (05) 523-535
    CrossrefPubMedGoogle Scholar
  • 26 Hopman WM, Towheed T, Anastassiades T. Canadian Multicentre Osteoporosis Study Research Group. et al. Canadian normative data for the SF-36 health survey. CMAJ 2000; 163 (03) 265-271
    PubMedGoogle Scholar
  • 27 Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health 1999; 53 (01) 46-50
    CrossrefPubMedGoogle Scholar
  • 28 Ware JE. SF-36 Health Survey: Manual and Interpretation Guide. Boston: New England Medical Center. Health Institute; 1997
    Google Scholar