high tibial osteotomy

• 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