High Tibial Osteotomy_UTSAV

High Tibial Osteotomy

1. HIGH TIBIAL OSTEOTOMY 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

3. Goal of HTO T o correct or even overcorrect the limb into valgus , which serves to redistribute the mechanical forces from the medial 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

8. Amount of corrective osteotomy required

9. Closing Wedge

10. Opening Wedge

11. Neutral

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

13. Lateral Closing Wedge Osteotomy

14. 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

15. 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

16. 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)

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

18. MEDIAL OPEN WEDGE OSTEOTOMY

19. Tomofix plate

20. Puddu-chambat plates

21. Staples

22. LRS and ilizarov

23. 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

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

25. 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

26. Effect On Cartilage ???

27. Results

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

29. THANK YOU Dr. Utsav Agrawal