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High tibial osteotomy: Why we choose a lateral closing wedge technique and what is our

Published in N°275 - June/July 2018
Article viewed 183 times

High tibial osteotomy: Why we choose a lateral closing wedge technique and what is our "ideal" patient?

By Michael Facek (1), Thomas Neri(2) (3), Leo Pinczewski (1) (4) in category TECHNIQUE
1) North Sydney Orthopaedic and Sports Medicine Centre, 2/3 Gillies St, Wollstonecraft, NSW, 205, Australia / 2) Sydney Orthopaedic Research Institute (SORI) / 3) Inter-university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon - Jean Monnet, France / 4) University of Notre Dame, Sydney, Australia

High tibial osteotomy (HTO) is a well-established surgical technique for the management of medial compartment osteoarthritis of the knee in the young, active patient; in this group, partial and total knee replacements are reported to have high failure rates.

Introduction

High tibial osteotomy (HTO) is a well-established surgical technique for the management of medial compartment osteoarthritis of the knee in the young, active patient; in this group, partial and total knee replacements are reported to have high failure rates (1). The purpose of HTO is to shift the lower limb mechanical axis laterally to redistribute weight-bearing forces away from the worn medial compartment and through the preserved lateral compartment (figure 1).

Figure 1: Preoperative (1a) and post-operative (1b) XR after closing wedge HTO.

 

This relieves pain and can encourage fibrocartilagenous regrowth over the eburnated medial femoral condyle. When successful, HTO permits high levels of activity, has excellent long term outcomes, and is readily revised to TKR if required. Furthermore, TKR performed after HTO has similar outcomes to primary TKR (2).

In this article we will outline our favoured surgical technique for HTO, including a rationale for our choice, and then provide a detailed description. We will also emphasise our patient selection criteria and present the supporting research.

 

Lateral closing wedge high tibial osteotomy

1) Why we choose the lateral closing wedge HTO

A lateral closing wedge high tibial osteotomy is our preferred surgical option...

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