Extract
To The Editor:In the article "Tibial Osteotomy for the Treatment of Varus
Gonarthrosis. Survival and Failure Analysis to Twenty-two Years"
(2003;85:469-74), Sprenger and Doerzbacher compiled an interesting statistical
retrospective analysis of osteotomy for the treatment of tibial gonarthrosis.
However, there seem to be certain flaws in the logic behind the technique
described. The authors did not provide conclusive biomechanical evidence of
the utility of this construct in preventing nonunion or malalignment due to
axial or angular stresses and torsional loads1,2. In addition,
application of a tension-band wire on the medial side would entail further
periosteal stripping, which is undesirable these days as there is a trend
toward the use of minimal implants, and the application of hardware on both
surfaces is not desirable3. Moreover, the exposure for applying
tension-band wiring after osteotomy requires a separate incision to be made
very near the site of plate application, hence decreasing the vascularity of
the intervening skin. Even if a single skin incision were used, it would
require a long exposure of the bone. The final clinical outcome with regard to
union of the osteotomy and pain relief did not vary significantly from the
outcomes reported in other series in which single-sided fixation constructs
had been used. This casts doubt on the usefulness of the medial tension-band
wiring3,4. The authors also seem to have changed the technique
described in the original article, by Sprenger et al.5, in which
the osteotomy was made proximal to the level of the tibial tuberosity and two
proximal screws and three distal screws were used; in the current study, three
proximal and four distal screws were used and the osteotomy was distal to the
tibial tuberosity, as shown in Figures 1-B and 1-C.