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Year : 2013  |  Volume : 47  |  Issue : 2  |  Page : 215-216
Author's reply

Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand

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Date of Web Publication16-Mar-2013

How to cite this article:
Pornrattanamaneewong C, Numkanisorn S, Chareancholvanich K, Harnroongroj T. Author's reply. Indian J Orthop 2013;47:215-6

How to cite this URL:
Pornrattanamaneewong C, Numkanisorn S, Chareancholvanich K, Harnroongroj T. Author's reply. Indian J Orthop [serial online] 2013 [cited 2020 Jan 25];47:215-6. Available from:

Thank you for your interest in our article entitled "A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee." [1] According to your concern about our technique, [2] medial opening wedge high tibial osteotomy (MOWHTO) using a Tomofix plate without any bone graft or substitute, we corrected the larger series of 68 patients who underwent 81 osteotomies with the use of this technique. [3] Non-united osteotomies and recurrent varus deformity were found to be 2.4% and 1.4%, respectively. No implant breakage was detected in our study. Although Miller et al. [4] reported the high rate of complications (36.9%) with this technique. Their study used Puddu plate or VS osteotomy plate fixation with autograft or allograft insertion. We thought that these kinds of two plates had too short lever arm to withstand the load. Several studies also confirmed that the use of Puddu plates had a higher complication rate (37.7-55%) [5],[6],[7] than using locking or non-locking T-plates (1.9-8.6%). [8],[9],[10] Additionally, the recent finite element analysis demonstrated that the Tomofix plate produces superior stability for bony fixation in MOWHTO procedures than the Puddu plate. [11] Therefore, type of implant had the significant effect to complication rate. Because of our concern about the disadvantages of bone substitute [12],[13] (including delayed incorporation into bone, soft tissue irritation, and infections) and the donor site morbidity from harvesting iliac bone graft, we purposed the technique of using a Tomofix plate without interposition materials, which has been previously recommended in several studies. [14],[15],[16],[17],[18] Our study shows satisfactory outcome with the same bone healing time as using bone substitute (within 8-12 weeks). [19] Finally, we appreciate the results of your technique that used tricalcium phosphate substitute alone and hope that results of it would be published for the benefit of other readers.

   References Top

1.Pornrattanamaneewong C, Numkanisorn S, Chareancholvanich K, Harnroongroj T. A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee. Indian J Orthop 2012;46:455-61.  Back to cited text no. 1
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2.Vaishya R. A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee. Indian J Orthop 2013;47:215.   Back to cited text no. 2
  Medknow Journal  
3.Pornrattanamaneewong C, Narkbunnam R, Chareancholvanich K. Medial proximal tibial angle after medial opening wedge HTO: A retrospective diagnostic test study. Indian J Orthop 2012;46:525-30.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Miller BS, Downie B, McDonough EB, Wojtys EM. Complicationsafter medial opening wedge high tibial osteotomy. Arthroscopy 2009;25:639-46.  Back to cited text no. 4
5.van den Bekerom MP, Patt TW, Kleinhout MY, van der Vis HM, Albers GH. Early complications after high tibial osteotomy: A comparison of two techniques. J Knee Surg 2008;21:68-74.  Back to cited text no. 5
6.Esenkaya I, Elmali N. Proximal tibia medial open-wedge osteotomy using plates with wedges: Early results in 58 cases. Knee Surg Sports Traumatol Arthrosc 2006;14:955-61.  Back to cited text no. 6
7.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;88:1454-9.  Back to cited text no. 7
8.Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal platefixator in patients with medial-compartment gonarthritis andvarusmalalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 2010;26:1607-16.  Back to cited text no. 8
9.Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grützner P. Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 2009;91:2581-8.  Back to cited text no. 9
10.Santic V, Tudor A, Sestan B, Legovic D, Sirola L, Rakovac I. Bone allograft provides bone healing in the medial opening high tibial osteotomy. Int Orthop 2010;34:225-9.  Back to cited text no. 10
11.Raja Izaham RM, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury 2012;43:898-902.  Back to cited text no. 11
12.Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 2004;124:649-53.  Back to cited text no. 12
13.Van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB. Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: A radiological study with a new evaluation system. Knee 2004;11:451-6.  Back to cited text no. 13
14.Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around theknee: Patient selection, stability of fixation and bone healing inhigh tibial osteotomies. J Bone Joint Surg Br 2008;90-B: 1548-57.  Back to cited text no. 14
15.Lobenhoffer P, De Simoni C, Staubli AE. Open-wedge high-tibial osteotomy with rigid plate fixation. Tech Knee Surg 2002;1:93-105.  Back to cited text no. 15
16.Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: Biomechanical investigation of the modified Arthrex Osteotomy plate (Pudduplate) and the Tomo Fix Plate. Clin Biomech 2004;19:944-50.  Back to cited text no. 16
17.El-Assal MA, Khalifa YE, Abdel-Hamid MM, Said HG, Bakr HM. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc 2010;18:961-6.  Back to cited text no. 17
18.Staubli AE, Jacob HA. Evolution of open-wedge high-tibial osteotomy: Experience with a special angular stable device for internal fixation without interposition material. Int Orthop 2010;34:167-72.  Back to cited text no. 18
19.Koshino T, Murase T, Saito T. Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 2003;85:78-85.  Back to cited text no. 19

Correspondence Address:
Thossart Harnroongroj
Department of Orthopedic Surgery, 2 Siriraj Road, Bangkoknoi, Bangkok, 10700
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Source of Support: None, Conflict of Interest: None

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