Rotational proximal tibial osteotomy surgical technique. 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. High tibial osteotomy hto is a reliable procedure to offload the affected compartment, thereby decreasing the effective intraosseous pressure within the lesion in an attempt to slow or prevent progression. Using the taylor spatial frame for a high tibial osteotomy provides a reliable way to achieve a successful high tibial osteotomy. Combined anterior cruciate ligament reconstruction and. High tibial osteotomy hto is a surgical procedure performed to relieve pressure on the damaged site of an arthritic knee joint.
Opening wedge osteotomy is done with the aid of radioscopy. Background high tibial osteotomy hto is an established treatment for. Surgical techniques and postoperative rehabilitation. This technique is for opening wedge high tibial osteotomy fixed with a spacer plate and anatomic softtissue autograft or allograft anterior cruciate ligament reconstruction, with proximal extracortical suspension and distal interference screw fixation. The cut is performed by the oscillating saw, alongside and below the two pins. The high tibial medial opening wedge osteotomy hto is a standard procedure in the treatment of varus gonarthrosis.
Effect of preoperative vitamin d deficiency on functional. High tibial osteotomy an overview sciencedirect topics. To secure the shaft portion of the plate onto the tibia, insert a unicortical selfdrilling locking screw into hole 2. Jun 19, 2017 scoliosis from childbirth trauma, neck, low back, ankle pain helped. High tibial osteotomy adam watson orthopaedic surgeon. Internal fixation offers the option for acute correction with a medial opening wedge and plate fixation.
The most important factor for success and low complications of hto is the precise correction of osteotomy. High tibial osteotomy hto for bow leg correction youtube. Tomofix osteotomy system surgical technique depuy synthes 11 surgical techniquemedial high tibia osteotomy 3 determine osteotomy position plan osteotomy type and position. Aug 30, 2019 perform a high tibial osteotomy hto is a realigning, joint sparing operation for osteoarthritis and malalignment of the knee. There are two main reasons to perform high tibial osteotomy.
Learn the high tibial osteotomy synthes tomofix plate surgical technique with step by step instructions on orthoracle. 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. High tibial osteotomy hto of the damaged knee joint. Hto produces a postoperative valgus limb alignment with shifting the loadbearing axis of the lower limb laterally. Mathes a physiotherapist can help you reduce some of the pain and swelling from the surgery post operative hinged knee brace. The purpose of this study was to define the role of cortical hinge fractures in the risk of nonunion and collapse of opening wedge high tibial osteotomy. The instruments also allow for alignment of the osteotomy to the sagittal and coronal planes to preserve tibial. 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.
Factors that can affect the success rate of high tibial osteotomy hto include patient selection, surgical technique, type of fixation hardware, supplemental fixation, choice of bone graft, and rehabilitation protocol. High tibial osteotomy hto is a widely accepted operation for medial tibiofemoral osteoarthritis and varus deformity of the lower extremity. This is an operation, which aims to change the weight bearing forces that pass through the knee. Aim 2 5 of valgus alignment in the mechanical axis 0 is normal 8 of anatomical valgus. For patients with medial compartment arthritis and a varus knee, its purpose is to provide years of relief prior to knee replacement. If one part of the joint is worn out, the angle of the leg bone can often be changed to shift stresses onto other areas that are not so worn.
High tibial osteotomy synthes tomofix plate surgical. Orthopedic surgery a procedure used for osteoarthritis in which a wedge of bone is excised from the tibial plate at the point of greatest contact with the femur. High tibial osteotomy is intended to transfer the mechanical axis to the midline of the knee, to reduce the unicompartmental load and subsequently delay osteoarthritis. Preoperative planning of medial opening wedge high tibial. 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. High tibial osteotomy hto is a widely performed procedure to treat medial knee arthrosis.
Limb alignment after openwedge high tibial osteotomy and its effect. This frequently leads to pain relief and, subsequently, improved function. Precise indication, preoperative planning, and operative technique selection are essential to achieve good results. Osteotomies around the knee for the young athlete with osteoarthritis. High tibial osteotomy hto protocol rehabilitation following high tibial osteotomy hto is an essential part of a full recovery and this process is comparatively prolonged versus alternative knee surgeries such as unicompartmental and total knee arthroplasties. High tibial osteotomy hto is an accepted method for treatment of medial knee osteoarthritis with varus deformity. Nyc high tibial osteotomy knee surgeon westchester knee. Open wedge high tibial osteotomy technique without bone. Improvements in surgical technique of valgus high tibial osteotomy. Opening wedge high tibial osteotomy and anterior cruciate. Factors affecting the union of opening wedge high tibial. The weightbearing part of the knee is shifted from degenerative or worn tissue onto healthier tissue.
Learn the proximal tibial osteotomy using a newclip plate. High tibial osteotomy synthes tomofix plate surgical technique. High tibial osteotomy hto postoperative instructions. Oct 16, 2018 a high tibial osteotomy is a surgical procedure that realigns the knee joint. Orthopedics today medial openingwedge high tibial osteotomy is a wellestablished procedure to correct varus malalignment of the lower limb in isolated medial compartment osteoarthritis of the. An operative technique and rehabilitation program to decrease complications and promote early union and function. It is commonly used to relieve pain when nonoperative treatments have failed.
This procedure afforded satisfactory results in a case series of 32 patients. This instructional surgical video shows the safe surgical technique of a medial opening wedge high tibial osteotomy hto using the tomofix system as. The contourlock hto plate is a great choice for high demand patients needing a stronger locking construct for weightbearing. The ideal candidate for an hto is a middle aged patient 60 to 65 years of. The osteotomy cut is performed in two steps b transverse osteotomy cut. Replace the spacer in hole 3 with a unicortical selfdrilling locking screw. This instructional surgical video shows the safe surgical technique of a medial opening wedge high. This is potentially associated with various complications. A comprehensive plating system for stable fixation of. Surgical technique a lateral approach is used to perform a distal femoral osteotomy. The ibalance hto system is ideal for any surgeon who desires to master high tibial osteotomies. High tibial osteotomy definition of high tibial osteotomy. A procedure known as a high tibial osteotomy wedges open the upper shin bone tibia to reconfigure the knee joint. Mark the osteotomy position by placing two parallel 2.
Scoliosis from childbirth trauma, neck, low back, ankle pain helped. Noyes fr, mayfield w, barberwestin sd, albright jc, heckmann tp. The proper correction of the mechanical axis in high tibial osteotomy. If you have osteoarthritis wear and tear and it only affects one side of the knee, it may be appropriate to have a hto. Objective to determine the radiographic outcomes following dome or wedge. Sep 30, 2003 the high tibial medial opening wedge osteotomy hto is a standard procedure in the treatment of varus gonarthrosis. 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. Victoria v8z 09 tel 250 940 4444 fax 250 385 9600 page 4 july 2015 v1s. As discussed above, high tibial osteotomy is a good method in treating patients with early arthritic changes or chondral defects affecting the medial compartment of the knee. This manipulation brings the bones together and fills the space left by the removed bone. Improvements in surgical technique of valgus high tibial. 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. High tibial osteotomy hto is the main biologic treatment option for most of these cases.
Osteotomy of the proximal tibial metaphysis to redistribute weight away from an affected compartment. The tomofix medial proximal tibial head plate is suitable for both opening and closingwedge osteotomies. In this procedure the surgeon makes an incision in front of the knee and removes a small wedge of bone from the upper part of the tibia or shin bone. Opening wedge high tibial osteotomy wheeless textbook of. The iliotibial band is split along its fibers and the vastus lateralis is elevated off the femur to expose the femoral shaft and metaphysis. Before osteotomy, arthroscopy of the knee should be performed to treat the joint lesions. Operative indications, current surgical techniques fixation, grafts, and navigation, advanced applications, and complications are discussed.
Effect of medial opening wedge high tibial osteotomy on. One goal of high tibial osteotomy is to alter the history of underlying osteoarthritis by unloading the articular surfaces5. The ideal candidate for an hto is a middle aged patient 60 to 65 years of age, with isolated medial osteoarthritis. Openwedge valgus high tibial osteotomy technique with. Clinical data of 209 patients 327 knees who underwent hto done by a single surgeon were retrospectively registered for the study. Previous studies have documented the effects of hto on. 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. Complications in high tibial medial opening wedge osteotomy. For some patients who have knee arthritis, this surgery can delay or. High tibial osteotomy decreases knee pain, allows higher activity levels. High tibial osteotomy hto is an established treatment for unicompartmental osteoarthritis with varus deformity in relatively active young patients with good knee mobility. To learn more about hto, schedule a consultation with dr.
High tibial osteotomy hospital for special surgery. A high tibial osteotomy is generally considered a method of prolonging the time before a knee replacement is necessary because the benefits typically fade after eight to ten years. The opening wedge osteotomy also allows the opening wedge high tibial osteotomy an operative technique and rehabilitation program to decrease. This surgical technique is authored by dr janet conway. In hto with concomitant cartilage procedures, the method to correct. This procedure is typically reserved for younger patients.
This jointsparing operation is successfully used for the correction of a misaligned joint knee in arthritic patients. High tibial osteotomy hto predominately done for varus deformities. Patients with medial osteoarthritis, varus alignment, and chronic anterior cruciate ligament. The opening wedge osteotomy also allows the opening wedge high tibial osteotomy an operative technique and rehabilitation program to decrease complications and promote early union and. High tibial osteotomy hto is a useful alternative in the treatment of symptomatic varus malalignment. Jun 29, 2016 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. 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. A breakaway osteotomy guide pin is inserted about 4 cm proximal to. Hto, or high tibial osteotomy, can be an alternative to joint replacement surgery or is used to increase the success of other types of knee joint treatments. Our elearning platform contains high resolution images and a certified cme of the rotational proximal tibial osteotomy surgical procedure.
High tibial osteotomy post operative rehabilitation protocol. Overthetop anterior cruciate ligament reconstruction and. Biplanar medial opening wedge high tibial osteotomy mowhto is a treatment method that allows adequate correction of symptomatic varus knee deformity. High tibial osteotomy works to shift the mechanical axis laterally which takes the force off the medial compartment4. The aim of this study was an analysis of complications and potential technical mistakes. Orthobullets team % technique video 0 % technique steps 0. Review of techniques and biomechanics high tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. You will be admitted to the hospital for an overnight stay following your operation. Struhl, one of new yorks top knee orthopedic surgeons. Results depend on surgical technique, type and severity of defect, motivation of the patient and early rom and rehabilitation. Chapter 62 combined anterior cruciate ligament reconstruction and high tibial osteotomy davide edoardo bonasia and annunziato amendola chapter synopsis this chapter describes the indications, planning, and surgical technique for combined anterior cruciate ligament acl reconstruction and high tibial osteotomy hto.
Multicompartmental osteochondral allografts of knee and. Although oats procedures offer many advantages, the literature on oats when performed alongside other procedures, including high tibial osteotomy, is limited. Operative technique for hight tibial osteotomy hto complications. Ninetyfour patients 94 knees who underwent hto were analyzed. On the other hand, patella baja often causes anterior knee pain and, over. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. Patientspecific instrumentation for high tibial osteotomy. The procedure changes the alignment of the heel bone calcaneus. The instruments also allow for alignment of the osteotomy to the sagittal and coronal planes to preserve tibial slope. Angular deformity in the knee leads to abnormal distribution of weight bearing stresses. This video demonstrates onestage, overthetop anterior cruciate ligament reconstruction with the use of gracilis and semitendinosus autograft in combination with closing wedge, lateral, biplanar high tibial osteotomy. Our elearning platform contains high resolution images and a certified cme of the proximal tibial osteotomy using a newclip plate. 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.
Dr conway is the director of bone and joint infection at the international center for limb lengthening and an attending orthopaedic surgeon at the. In this chapter we describe the surgical technique for medial opening wedge hto. Do different tibial osteotomy techniques affect sagittal. High tibial osteotomy postoperative rehabilitation protocol. This study aimed to evaluate the effects of vitamin d deficiency on the functional outcomes following a high tibial osteotomy hto. Contrary to a knee replacement which requires resection and replacement of the worn ends of the bone and in the case of a total knee replacement, resection of the anterior cruciate ligament as well. Longterm results and comparison of the three different high tibial. High tibial osteotomy plantation knee arthritis fort. A stepbystep guided technique of the ibalance hto system builds surgeon confidence through safety and reproducibility. Htos redistribute weight, and may v cartilaginous wear. Acute correction of varus knee by biplanar medial opening.
A total of 55 consecutive patients who underwent high tibial osteotomy were observed at a mean of 20 months postoperatively. High tibial osteotomy surgical technique orthopaedic. High tibial osteotomy is commonly recommended for patients under 55 years of age with a mobile knee. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. You will meet a physiotherapist in the recovery room or on the orthopedic floor. However, mowhto tends to decrease patellar height and increase the posterior tibial slope, which can affect the knee joint stability. 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 osteoarthritis and malalignment of the knee. May 31, 2012 high tibial osteotomy hto is a widely performed procedure to treat medial knee arthrosis. The therapist will show you how to lockunlock your brace. The titanium contourlock hto plates were designed to be a anatomically curved and low profile. A high tibial osteotomy is a surgical procedure that realigns the knee joint. In this procedure, the surgeon makes an incision in front of the knee and removes a small wedge of bone from the upper part of the tibia or shin bone. Our elearning platform contains high resolution images and a certified cme of the high tibial osteotomy synthes tomofix plate surgical procedure. Learn the rotational proximal tibial osteotomy surgical technique with step by step instructions on orthoracle.
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