This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.

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