High Tibial Osteotomy

1. Dr. Utsav
Agrawal

2.  Credited to Jackson and Waugh (1961)
 High tibial osteotomy (HTO) corrects alignment of the
knee, relieving pressure from the arthritic portion of
the joint, and transferring it to an area of more normal
cartilage.
 This frequently leads to pain relief
and, subsequently, improved function.
 Well established procedure for unicompartmental
arthritis with 80 % satisfactory results.
 Biomechanical basis  unloading of the affected
compartment

4. NORMAL VARUS
DEFORMITY

5. Indications
 Pain and disability interfering employment or
recreation
 Radiographic evidence of degenerative changes
confined to 1 compartment with malalignment
 Ability to carry out proper rehabilitation program
 Medial knee pain asso. With cartilage defect

6. Contraindications
 Correction needed >20˚
 Flexion contracture >15˚
 Knee flexion <90˚
 Tibial subluxation >1cm
 Medial compartment tibial bone loss >3mm
 Patella baja
 Inflammatory arthritis
 Morbid obesity
 Relative  Age >60yrs

7. Load sharing by the medial and
lateral compartment
Position % weight through medial comp
Normal i.e. 2˚ varus 75 %
Centre 70%
4˚ valgus 50%
6˚ valgus 40%
3˚-6˚ mechanical valgus is recommended for treatment of MCOA

10. Amount
of
corrective
osteotomy
required

11. Closing Wedge

12. Opening Wedge

13. Neutral

14. Procedures
 Lateral closing wedge osteotomy (Coventry)
 Medial open wedge osteotomy with bone graft
(Hernigou)
 Opening wedge hemicallotasis (Turi)
 Barrel vault / Dome osteotomy (Maquet)

16.  First by Jackson and Waugh (1961)  was either a
closing wedge or dome with osteotomy distal to
tuberosity
 Coventry (1965)  closing wedge osteotomy proximal
to tibial tuberosity

17. Amount of wedge to be resected
If tibia is 57 mm wide, length of wedge=degrees of correction
OR
Length = Diameter of tibia X 0.02 X Angle

19. Management of Fibula
 1.> Osteotomy distal to fibular neck
 2.> Resection of proximal tibio-fibular syndesmosis
(Insall)
 3.> Resection of fibular head with
advancement of LCL insertion(Coventry)

20. Pros
 Most stable
 Early consolidation
 Early mobilisation
 Exploration of knee joint through same approach
Cons
 Limb shortening
 Nerve injury
 LCL laxity
 Patella Baja

23. Tomofix plate

24. Puddu-chambat plates

25. Staples

26. LRS and ilizarov

27. Advantages
 Usual deformity is proximal tibia vara, which is
addressed directly
 Preservation of bone at proximal tibia
 No disruption of proximal tibio fibular joint or anterior
compartment
 Less chances of nerve injury
 Correction can be modified intra-operatively

28. Disadvantages
 Non-union
 Longer time to consolidation
 Longer duration of immobilisation
 Donor site morbidity
 Limb lengthning
 Shifts tibial tubercle laterally  Patello-femoral
symptoms

29. Opening Wedge hemicallotasis
 Schwartsman  After tibial osteotomy Ilizarov
Advantages :
• More reliable healing
• Less chances of patella baja
• Less bone loss
• Ability to translate distal fragment to correct
mechanical axis
Disadvantages :
• Cumbersome, reduced complaince
• Pin loosening
• Pin site infection
• Turi et al  dynamic uniplanar external fixator

31. Effect
On
Cartilage ???

32. Results

34. Complications
 Recurrence
 Infection
 Non-union
 Stiffness
 Common peroneal injury
 Intra-articular fracture
 Patella baja
 Osteonecrosis of proximal fragment
 Vascular injury

35. Dr. Utsav Agrawal