Comparing dome high tibial osteotomy for patients more than sixty years old with patients less than sixty years old

Background: Although high tibial osteotomy for varus deformity in younger patients has been proven effective and proper for the treatment of painful osteoarthritis, the role of dome high tibial osteotomy for osteoarthritis knee in patients older than 60 years old in good selected cases is still the proper choice of surgery. Objective: To study the outcome of high tibial osteotomy for osteoarthritis knee in patients older than 60 years. Methods: We evaluated the results in eighty-eight patients (one hundred and ten knees) that had been treated by dome high tibial osteotomy and fixed with Charnley’s external fixator for varus deformity and osteoarthritis of the medial compartment. In the retrospective study, patients were divided into two groups. In the first group, there were 50 knees of 39 patients under 60 years. The second group was 60 knees of 49 patients over 60 years. The results were evaluated using the Knee Society score, the rating system described by Coventry, anatomical femorotibial axis, survivorship analysis with total knee arthroplasty as the end point and complications. Results: In the first group whose ages were under 60, the mean preoperative and postoperative Knee Society scores were 62 and 85.98, respectively (p<0.05). The mean preoperative anatomical femorotibial axis had improved from varus 4.39 degrees to valgus 6.48 degrees. Survivorship analysis with total knee arthroplasty as the end point was 100% at five years and 78.13±11.28% at ten years. In the second group (over 60), the mean preoperative and postoperative Knee Society scores were 64.02 and 88.20, respectively (p<0.05). The mean preoperative anatomical femorotibial axis improved from varus 5.03 degrees to valgus 7.56 degrees. The survivorship analysis with total knee arthroplasty as the end point was 98.3±1.65% at five years and 83.21±9.94% at 10 years. Conclusion: Dome high tibial osteotomy using Charnley’s external fixator was as effective a procedure for treatment of medial osteoarthritis in patients over 60 years as in patients under 60 years. We highly recommend dome high tibial osteotomy with minimal invasive technique and fixed with Charnley’s external fixator for patients both younger and older than 60 years in good selected cases who wish to continue an active lifestyle.