HTO high tibial osteotomy still a role.pptx

HTO
High tibial osteotomy

1. HTO- There Is Still A Role Dr.Balaji Zacharia Dept. Of Orthopaedics Govt. Medical College, Kozhikode

2. Objectives Introduction Role of HTO Types Complication TKA after HTO

3. Advantages Reconstruction osteotomy Correct deformity and regain pre-op ROM No activity modification C heap Later TKR

4. Disadvantages Recovery takes longer time Pain relief not predictable Later TKR technically challenging

5. Indications Young active patients with medial compartment osteoarthritis Meniscal transplantation in varus knee Cartilage repair in isolated chondral defects in varus knee Ligamentous instability with varus thrust

6. Contraindicatins RA Varus > 15 Joint incongruity Lateral thrust > 1cm Hip and ankle deformity PVD

7. HTO - 10 year outcome 26 % conversion to TKA 65% patient satisfied 21% complication 10% CPN palsy ( Sprenger Doerzbacher , JBJS 2003)

8. Author Year n 10 yrs Survival Rate Aglietti 2003 102 78% Billings 2000 64 53% Cass 1988 86 69 % Coventry 1993 87 66 % Hernigou 2001 245 85 % Majima 2000 48 61 % Naudie 1999 85 80 % Ritter 1988 78 58 % Rudan 1991 128 80 % Sprenger 2003 66 74 % Insall & Scott: Surgery of the Knee, 5 th Ed

9. Cochrane Review 13 Articles reviewed No evidence to suggest better than conservative management Results so far do not justify a conclusion about specific surgical techniques All studies showed less pain and improved knee function 2 months to 7.5 years after any type of osteotomy

10. Revision rates : At 10years (< 55yrs) HTO - 17 % Uni . - 24% TKR - 9% ( Acta Orthop 2010;81(2): 161-164)

11. Types CWHTO OWHTO Dome osteotomy Chevron

12. Advantages OWHTO Simple – single osteotomy No fibular osteotomy No resection of tibia No alteration in shape of proximal tibia Prevent or treat shortening CWHTO Early Union Early rehabilitation and weight bearing Inspect the articular surface intraoperatively Low risk of loss of correction

13. Disadvantages OWHTO Nonunion Loss of posterior tibial slope Lengthening Long period of restriction of weight bearing CWHTO Fibular osteotomy N-V complication Shortening Patellar ligament laxity Truncation

14. Candidates for OWHTO >/= 2mm shortening Patella alta PCL injury MCL injury CWHTO Risk of nonunion Don't want BG Patella infera Want to do ACL reconstruction simultaneously

15. Dome osteotomy Technically more demanding Injury to patellar tendon Precise correction of angulation Anterior translation of tibial tubercle is possible reducing the patellofemoral problems

16. Factors affecting prognosis Age BMI Grade of OA ROM Instability

17. Complications of HTO Nonunion (0.7 – 4.4 %) Lateral/ medial cortical and intra articular fractures Patella infera (6-7%) poor result in HTO , later TKR difficult Fixation failure DVT Compartment syndrome

18. TKA after HTO Male Young patients Obese patients OWHTO is better Long term studies shown that there is not much difference in outcome b/w primary and post HTO TKA

19. Soft tissue Incision Stiff knee – quadriceps release Patella Baja , contracted ligaments, instability PS is better CR

20. Bone Patella baja - low femoral cut Bone deficiency - less tibial resection Tibial offset change - under size tibial tray with offset stem Malunion – semiconstrained implant Nonunion – long stem tibial component + ORIF & BG

21. Implant Retain / removal Single / two stage Infection

22. Conclusion HTO is an effective and successful procedure Careful patient selection for high satisfaction Surgeons should not avoid doing HTO for fear of difficulties of later conversion to TKA

23. Thank You