Two plate options, standard and small, are available to accommodate varying patient anatomy. The ibalance hto surgical technique starts with an instrument system highly specific to the ibalance implants that creates a safety envelope with lockedin retractors, allowing the surgeon to create all cuts safely and reproducibly, while significantly reducing chances of neurovascular injury and lateral hinge fractures. For the treatment of varus arthrosis, common in athletes, a medial opening, high tibial osteotomy is a very useful tool. Medial opening hto had been developed, because it had some advantages over the closed wedge technique. However, maximizing procedural success and postoperative knee function still possess many difficulties.
The simplistic design facilitates minimally invasive surgery and is optimal for lower demand patients. For some patients who have knee arthritis, this surgery can delay or prevent the need for a partial or total knee replacement by preserving damaged joint tissue. Our elearning platform contains high resolution images and a certified cme of the high tibial osteotomy synthes tomofix plate surgical procedure. The advantages of this technique include no need for bone grafting, less morbidity and faster healing and greater potential for correction. A procedure known as a high tibial osteotomy wedges open the upper shin bone tibia to reconfigure the knee joint. High tibial osteotomy recovery procedure and advantages. The instruments also allow for alignment of the osteotomy to the. High tibial osteotomy an overview sciencedirect topics. Opening wedge high tibial osteotomy using a puddu plate. High tibial osteotomy is considered as a joint preservation technique that can delay the need for knee replacement. Journal of the american academy of orthopaedic surgeons, 19, 590599.
A high tibial osteotomy is a surgical procedure that realigns the knee joint. Clinical indications include varus alignment of the knee associated with medial compartment arthrosis, knee instability, medial compartment overload following meniscectomy, and. Previous studies have documented the effects of hto on. The ideal candidate for an hto is a middle aged patient 60 to 65 years of. This surgical technique is authored by dr janet conway.
Using the taylor spatial frame for a high tibial osteotomy provides a reliable way to achieve a successful high tibial osteotomy. The high tibial medial opening wedge osteotomy hto is a standard procedure in the treatment of varus gonarthrosis. Technique selection for high tibial osteotomy factors to consider when performing proximal tibial valgus osteotomy include leg length discrepancy, medial joint laxity, acl laxity, presence or absence of an osteochondral defect on the medial femoral condyle, joint line obliquity, a patient who is a prior smoker or presently is smoking, opiate. In general, published studies on hto report good longterm results with a correct patient selection and a precise surgical technique. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. High tibial osteotomy by dr bhushan sabnis youtube. High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. The role of high tibial osteotomy in the varus knee. High tibial osteotomy hto is a commonly used surgical technique for treating moderate osteoarthritis oa of the medial compartment of the knee by shifting the center of force towards the lateral compartment. Openwedge valgus high tibial osteotomy technique with. High tibial osteotomy, also known as proximal tibial ostetotomy, has become a common surgical intervention used to treat patients with medial compartment arthritic changes and tibiofemoral malalignment, specifically lower extremity varus malalignment.
However, the technique has been associated with high nonunion rates, long period of. Depuy synthes trauma 2017 tomofix tm medial high tibial plate mht. A comprehensive plating system for stable fixation of. High tibial osteotomy is a surgical procedure performed to relieve pressure on the damaged site of an arthritic knee joint. The oblique high tibial osteotomy technique without bone removal and with rigid blade plate fixation for the treatment of medial osteoarthritis of the varus knee. Compression of the lateral hinge features and benefits higher stability four locking screws in the plate head long shaft portion evenly transmits the occurring forces into the tibial shaft. High tibial osteotomy rehabilitation guidelines the following is a detailed outline of the rehabilitation regime for patients who have had a high tibial osteotomy by dr. Chapter 70 high tibial osteotomy mark mcconkey, sami abdulmassih and annunziato amendola chapter synopsis high tibial osteotomy hto is a valuable procedure and, when performed with attention to appropriate indications and contraindications, has good outcomes reported in the literature. Medial openwedge high tibial osteotomy hto is recognised as a surgical option in dealing with medial osteoarthritis or varus malalignment of the knee joint. This is potentially associated with various complications.
Osteotomies of the thighbone femur are done using the same technique. This instructional surgical video shows the safe surgical technique of a medial opening wedge high tibial osteotomy hto using the tomofix system as. High tibial osteotomy isakos arthroscopy knee surgery. Keywords high tibial osteotomy allograft osteoarthritis introduction unicompartment osteoarthritis of the knee is associated. It is usually performed in arthritic conditions affecting only one side of your knee and the aim is to take pressure off the damaged area and shift. To start, the most noticeable landmarks, including the tibial tubercle, joint line and fibular head, are outlined on the patients skin. High tibial osteotomy hto for bow leg correction youtube. The lateral closed wedge high tibial osteotomy hto described by jackson and coventry 1,2 is a classical operation to treat osteoarthritis of the medial compartment and varus deformity, but it has some problems such as peroneal nerve palsy, nonunion of fibula, and loss of the bone. The osteotomy means actually the cutting of edge of bone that could be in shinbone called tibia or femur bone called thighbone. High tibial osteotomy plantation knee arthritis fort.
A total of 85 patients 49 male and 36 female suffering from varus gonarthrosis underwent a medial opening wedge hto. Ensure the osteotomy line extends from the tibial tuberosity along the posteromedial aspect of. Our elearning platform contains high resolution images and a certified cme of the rotational proximal tibial osteotomy surgical procedure. This procedure is generally recommended for younger persons experiencing pain due to instability and malalignment. In this chapter we describe the surgical technique for medial opening wedge hto. Learn the rotational proximal tibial osteotomy surgical technique with step by step instructions on orthoracle. The ideal candidate for an hto is a middle aged patient 60 to 65 years of age, with isolated medial osteoarthritis. What are the benefits of high tibial osteotomy with openwedge technique in varus oa of the knee. Myers, mbbs, fracs, faortha, australia philippe noel neyret, md, phd, prof. Improvements in surgical technique of valgus high tibial. Limb alignment after openwedge high tibial osteotomy and its effect. High tibial osteotomy recovery is fast now and in the kids is very safe but when it is required and how it is done to know this read this article. High tibial osteotomy hto is usually performed as an effective surgical intervention for patients with medial knee osteoarthritis and varus.
This instructional surgical video shows the safe surgical technique of a medial opening wedge high tibial osteotomy hto using the tomofix system as a locked internal fixator without the need for. Orthofix us extremities xraybased pre and postoperative planning of deformity correction surgery with computerassisted hexapod system. They are usually done to correct a knockkneed alignment. If a patient benefits from the brace, they are likely to benefit from surgery. High tibial osteotomy hto is a useful alternative in the treatment of symptomatic varus malalignment. Benefits of opposite screw insertion technique in medial. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. There are many options for performing a high tibial osteotomy. Learn the high tibial osteotomy synthes tomofix plate surgical technique with step by step instructions on orthoracle. With each step you take, forces equal to 3 to 8 times your body weight travel between the femur thighbone. In the process of a knee osteotomy, the tibia or femur bone is cut. Effect of medial opening wedge high tibial osteotomy on. Hto produces a postoperative valgus limb alignment with shifting the loadbearing axis of the lower limb laterally. The tomofix medial proximal tibial head plate is suitable for both opening and closingwedge osteotomies.
After an hto reconstruction, the initial postop dressing should be. Amyn rajani, orthopaedic surgery specialists in mumbai says that high tibial osteotomy too has its share of complications. High tibial osteotomy hto is a surgical procedure aimed repositioning. We present four technical modifications of high tibial osteotomy which improve its safety and reproducibility. Anterior knee pain and patella instability is a common orthopaedic problem. On the other hand, patella baja often causes anterior knee pain and, over. High tibial osteotomy synthes tomofix plate surgical. Internal fixation offers the option for acute correction with a medial opening wedge and plate fixation. Tibial osteotomy was first performed in europe in the late 1950s and brought to the united states in the 1960s. Opening wedge high tibial osteotomy wheeless textbook of. Previously, this technique was used to correct knee disease with inadequate varus deformity 1, 2, and several studies with statements on postponing the necessity of total knee. High tibial osteotomy is a surgical procedure to relieve pressure on the damaged site of an arthritic knee joint. This instructional surgical video shows the safe surgical technique of a medial opening wedge high tibial osteotomy hto using the tomofix system as a locked internal fixator without the need for bone grafting.
A precise overview on indications, patients selection, preoperative planning, surgical technique, methods of fixation, and complications have been presented. Complications in high tibial medial opening wedge osteotomy. Rotational proximal tibial osteotomy surgical technique. Acute correction of varus knee by biplanar medial opening. In high tibial osteotomy, a triangular wedge of bone is cut at the upper end of the tibia and either removed or filled with bone graft depending on the patients needs. Mark the osteotomy position by placing two parallel 2.
The weightbearing part of the knee is shifted from degenerative or worn tissue onto healthier tissue. The most commonly used surgical techniques for high tibial osteotomy include lateral close wedge osteotomy, medial open wedge osteotomy and dome osteotomy. Opening wedge high tibial osteotomy using tibial wedge. Each case can be very different depending on the goals of the patient, the age of the patient, the type of surgery etc. Longterm results and comparison of the three different. This procedure is sometimes called a high tibial osteotomy. High tibial osteotomy complications orthopaedic surgery. The surgical technique involves making an incision over the tibia, below the knee joint. High tibial osteotomy hto is a widely performed procedure to treat medial knee arthrosis. Patientspecific instrumentation for high tibial osteotomy. Dr conway is the director of bone and joint infection at the international center for limb lengthening and an attending orthopaedic surgeon at the. Open wedge high tibial osteotomy technique without bone. A wedge of bone is removed, based on the surgeons calculations, to allow the angle of the knee to be adjusted.
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