High tibial osteotomy

1,153
-1

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,153
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
78
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

High tibial osteotomy

  1. 1. • SUCCESS IN ARTHROPLASTY IN RECENT DECADES •HTO DOWNGRADED LATELY •40%-50% CONVERSION TO TKA (10 YRS) •HTO CONSIDERED OPTIONAL DELAY •AFFORDABLE
  2. 2. •PATIENT RETAINS ALL PREOP.MOVEMENTS •NO CHANGE IN LIFESTYLE •LESS EXPENSIVE •SUITABLE FOR YOUNG PATIENTS
  3. 3. TO RESTORE MECHANICAL AXIS TO MIDLINE OF KNEE
  4. 4. •HTO PRECEEDED TKA BY TEN YEARS •POPULARITY OF ARTHROPLASTY IN 1970’S •1961 :JACKSON AND WAUGH FIRST TIBIAL OST JBJ 43B:746, 1961 •1965 COVENTRY M.B. (CLOSING WEDGE OST.) JBJ 47A :984,1965
  5. 5. COVENTRY 1979 (18 YRS RESULTS) ,60% PATIENTS FUNCTION RESTORED EVEN AFTER 10 YRS OF SURGERY. ORTHO.CL.OF NA,10:191,1979 MAQUET 1976 DOME OST. ,MORE ACCURACY & ADJUSTABILTY INHERENTLY STABLE , FIXATION OPTIONAL TURI 1987 – MEDIAL OPENING WEDGE OST. MANGAL PARIHAR 2009 – Medial opening wedge through Distraction Osteogensis (ex.fix.) (ref: www.ilizarov.in/casestudies/high-tibial-osteotomy.html.)
  6. 6. COVENTRY’S SURGICAL TECHNIQUE
  7. 7. MAQUET
  8. 8. Medial Open Wedge Osteotomy
  9. 9. Medial wedge opening high tibial ostetomy using ext. Fixator for gradual distraction osteogenesis techquine Pre-op clinical appearance and x-rays standing position
  10. 10. Medial wedge opening high tibial ostetomy using ext. Fixator for gradual distraction osteogenesis technique ILIZAROV Principles Immediate post-op
  11. 11. •ISOLATED MONOCOMP. OA OF KNEE •PHYSIO. AGE <65 YRS •ABSENCE OF MORBID OBESITY •MINIMUM PREOP. RANGE OF FLEX .90⁰
  12. 12. • EXTENSION DEFICIT <15⁰ • PASSIVELY CORRECTABLE VARUS DEF. <15⁰ •LATERAL TIBIAL SUBLUX. <1 CM • ABSENCE OF LIG. INSTABILITY
  13. 13. •NORMAL VALGUS ALIGNMENT 5⁰-8⁰ •1⁰ CORRECTION FOR EACH mm LENGTH AT BASE OF WEDGE AIM TO CALCULATE CORRECTION FROM VARUS TO NORMAL VALGUS BY REMOVING OR OPENING AN ACCURATE WEDGE
  14. 14. Post op x-ray
  15. 15. Post-op 3 day
  16. 16. I .LAKSHMI , AGE-45 (AMALAPURAM)
  17. 17. •LOSS OF CORRECTION 5%-30% •PERONEAL NERVE PALSY •NON UNION •INFECTION •KNEE STIFFNESS •INSTABILTY •INTRA ART. FRACTURE •VENOUS THROMBOSIS
  18. 18. •TECH. MORE DEMANDING •40% HTO NEED CONVERSION TO TKA AFTER 10 YRS •28% FAILURE OF UKA AFTER FAILED HTO. REES et al .JBJ .83B:1034,2001 •NO DIFFERENCE BETWEEN PRIMARY TKA AND HTO CONVERSION MEDING .J.B et al JBJ.82A :1252 ,2000 HADDAD AND BENTLEY J.ARTHROPLASTY 15:597,2000
  19. 19. •UKA ALLOWS UNCOMPLICATED REVISION LATER ? •BUT 76% REVISIONS SHOWED MAJOR OSSEOUS DEFECTS AFTER UKA. PADGETT ,STEIN & INSALL JBJ 73A :186,1991 • DIFFICULTY IN EXPOSURE AND SLIGHTLY LESS SATISFACTORY RESULTS OF TKA AFTER HTO. (CLOSING WEDGE)
  20. 20. 1. HTO is a very useful option in young patients for unilateral OA 2. Good Relief of pain can last per ten years or longer 3. Less expensive 2. Short learning curve
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×