High tibial osteotomy using Puddu plate versus anatomic locked plate (Tomofix), a randomized control trial

Purpose: To compare the functional and radiological results for medial opening wedge high tibial osteotomy (MOWHTO) using the Puddu plate versus the Tomofix plate.

Methods: This study included sixty patients, thirty-eight females and twenty-two males. Patients were equally distributed into two groups, Group A fixed using the Puddu plate, and Group B fixed using the Tomofix plate. All patients were followed up for at least one year following surgery. Functional outcomes were assessed using the Hospital for Special Surgery (HSS) and the Oxford Knee Scores. The medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKA), and posterior tibial slope angles were evaluated radiologically both preoperative and at 1-year follow-up. Operative time, incision length, and time interval to achieve bone union were compared between both groups.

Results: The HSS and Oxford knee Scores at 1-year follow-up showed no statistically significant differences between both groups (p-value<0.05). No statistically significant differences were observed between both groups regarding the time interval to achieve bone union (p-value 0.63). The Tomofix plate group showed statistically significant larger skin incisions and longer operative time compared to the Puddu plate group (p-value <0.001). In addition, MPTA, HKA, and PTS at 1-year follow-up showed no statistically significant differences between both groups.

Conclusion: MOWHTO using Puddu and Tomofix plates provided comparable postoperative clinical and radiological results. Both implants can be considered safe and reliable options for correction of varus mal-alignment of the lower limb in patients with isolated medial knee osteoarthritis.

Level of evidence: Level II, prospective randomized comparative study.