High tibial osteotomy
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High tibial osteotomy

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High tibial osteotomy High tibial osteotomy Presentation Transcript

  • • SUCCESS IN ARTHROPLASTY IN RECENT DECADES •HTO DOWNGRADED LATELY •40%-50% CONVERSION TO TKA (10 YRS) •HTO CONSIDERED OPTIONAL DELAY •AFFORDABLE
  • •PATIENT RETAINS ALL PREOP.MOVEMENTS •NO CHANGE IN LIFESTYLE •LESS EXPENSIVE •SUITABLE FOR YOUNG PATIENTS
  • TO RESTORE MECHANICAL AXIS TO MIDLINE OF KNEE
  • •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
  • 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.)
  • COVENTRY’S SURGICAL TECHNIQUE
  • MAQUET
  • Medial Open Wedge Osteotomy
  • Medial wedge opening high tibial ostetomy using ext. Fixator for gradual distraction osteogenesis techquine Pre-op clinical appearance and x-rays standing position
  • Medial wedge opening high tibial ostetomy using ext. Fixator for gradual distraction osteogenesis technique ILIZAROV Principles Immediate post-op
  • •ISOLATED MONOCOMP. OA OF KNEE •PHYSIO. AGE <65 YRS •ABSENCE OF MORBID OBESITY •MINIMUM PREOP. RANGE OF FLEX .90⁰
  • • EXTENSION DEFICIT <15⁰ • PASSIVELY CORRECTABLE VARUS DEF. <15⁰ •LATERAL TIBIAL SUBLUX. <1 CM • ABSENCE OF LIG. INSTABILITY
  • •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
  • Post op x-ray
  • Post-op 3 day
  • I .LAKSHMI , AGE-45 (AMALAPURAM)
  • •LOSS OF CORRECTION 5%-30% •PERONEAL NERVE PALSY •NON UNION •INFECTION •KNEE STIFFNESS •INSTABILTY •INTRA ART. FRACTURE •VENOUS THROMBOSIS
  • •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
  • •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)
  • 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