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
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
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
14. Procedures
Lateral closing wedge osteotomy (Coventry)
Medial open wedge osteotomy with bone graft
(Hernigou)
Opening wedge hemicallotasis (Turi)
Barrel vault / Dome osteotomy (Maquet)
15.
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
18.
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
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