Introduction High tibial osteotomy (HTO) predominately done for varus deformities less common for valgus deformities Angular deformity in the knee leads to abnormal distribution of weight bearing stresses can accelerate wear in medial or lateral compartments of the knee and lead to degeneration HTO is commonly combined with cartilage restoration procedures to provide better mechanical environment for biologic repair Prognosis varus-producing high tibial osteotomy success rate is 87% in 10 years valgus-producing high tibial osteotomy success rate is 50-85% in 10 years Indications Indications young, active patient (<50 years) in whom an arthroplasty would fail due to excessive wear healthy patient with good vascular status non-obese patients pain and disability interfering with daily life only one knee compartment is affected compliant patient that will be able to follow postop protocol General contraindications inflammatory arthritis obese patient BMI>35 flexion contracture >15 degrees knee flexion <90 degrees procedure will need >20 degrees of correction patellofemoral arthritis ligament instability varus thrust during gait Anatomy Mechanical axis of lower extremity can be assessed by drawing straight line from center of femoral head to the center of the ankle joint line axis should pass just medial to the medial tibial spine Presentation Symptoms pain on medial or lateral side of knee Exam knee malalignment Imaging Radiographs show knee malalignment using mechanical axis line Varus-producing tibial osteotomy Surgical goals unload the involved joint compartment by correcting tibial malalignment maintain the joint line perpendicular to mechanical axis of the leg Indications can be done for valgus knee with lateral compartment degeneration deformity should be <12 degrees or else the joint line will become oblique specific contraindications medial compartment arthritis loss of medial meniscus distal femoral osteotomy better if lateral femoral condyle hypoplasia present Valgus-producing tibial osteotomy Goals unload the involved joint compartment by correcting tibial malalignment maintain the joint line perpendicular to mechanical axis of the leg Indications can be done for varus knee with medial compartment degeneration (more common) best results achieved by overcorrection of the anatomical axis to 8-10 degrees of valgus specific contraindications narrow lateral compartment cartilage space with stress radiographs loss of lateral meniscus lateral tibial subluxation >1cm medial compartment bone loss >2-3mm varus deformity >10 degrees Technique lateral closing wedge technique most common technique wedge of bone removed with tibia via an anterolateral approach ORIF of wedge has advantages more inherent stability allows for faster rehab and weight bearing no required bone grafting medial opening wedge technique transverse bone cut made in proximal tibia, and wedged open on medial side ORIF of wedge has advantages of maintaining posterior slope avoids proximal tibiofibular joint avoids peroneal nerve in anterior compartment focal dome osteotomy (concavity proximal) the center of the dome is located at the center of rotation of angulation (CORA) has advantages corrects limb alignment with the least translation of bone ends least translation of anatomical axis minimal shortening Complications Recurrence of deformity 60% failure rate after 3 years when failure to overcorrect patients are overweight Loss of posterior slope Patella baja refers to a shortened patellar tendon which decreases the distance of the patellar tendon from the inferior joint line can be caused by raising tibiofemoral joint line in opening wedge osteotomies can be caused by retropatellar scarring and tendon contracture can cause bony impingement of patella on tibia Compartment syndrome Peroneal nerve palsy more common in lateral opening wedge osteotomy and lateral closing wedge osteotomy minimal risk in medial opening wedge osteotomy Malunion or nonunion
Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Revision TKR Orthobullets Team Recon - TKA Instability Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Parapatellar Approach Derek Bernstein Stephen Incavo Recon - TKA Metal Hypersensitivity Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. High Tibial Osteotomy Orthobullets Team Recon - High Tibial Osteotomy
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.105) Patella baja is most likely to occur after which of the following procedures? Review Topic QID: 3528 1 Arthroscopic ACL reconstruction with cadaver allograft 1% (51/4035) 2 PCL reconstruction using tibial inlay technique 1% (34/4035) 3 High tibial osteotomy 85% (3426/4035) 4 MPFL reconstruction with semitendinosus autograft 2% (79/4035) 5 Total knee arthroplasty (TKA) 11% (437/4035) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Medial Compartment Arthritis: Osteotomy or Arthroplasty? - Michael Stuart, MD (3.21, 2018 Winter SKS) Michael Stuart Recon - High Tibial Osteotomy 8/8/2018 245 views Login to View Community Videos Login to View Community Videos Video Spotlight: Distal Femoral Tibial Osteotomy - Andreas H. Gomoll, MD (3.20, 2018 Winter SKS) Andreas Gomoll Recon - High Tibial Osteotomy 8/8/2018 165 views Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Proximal Tibial Osteotomy- Michael Stuart, MD (3.19, 2018 Winter SKS) Michael Stuart Recon - High Tibial Osteotomy 8/8/2018 277 views See More See Less
Varus Knee with Cartilage and Meniscal Damage in 32 Year Old (C2647) Recon - High Tibial Osteotomy HPI - 32M presents with medial-sided left knee pain. He previously underwent a partial medial meniscectomy for an "irreparable tear" at age 18 after a soccer injury. He returned to his regular activities and has continued playing soccer since his initial surgery, but over the past 3 years has complained of progressive left knee pain, isolated to the medial side of his knee. He also notes a mild bow-legged deformity of his left leg. Currently, he rates his pain as 9/10 in severity which is aggravated by activity. 3-foot standing XRays are obtained, which illustrate significant isolated medial compartment arthrosis. A diagnostic arthroscopy is undertaken - images of the medial and lateral compartments are shown. Significant bipolar lesions of the medial compartment are seen, with full thickness articular cartilage loss in addition to meniscal pathology. How would you manage this patient? 8/4/2016 6944 73 4