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Total Knee Replacement After High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 54-57 | Vijay C. Bose , Kalaivanan Kanniyan

DOI:10.13107/aja.2021.v06i02.035


Author: Vijay C. Bose [1], Kalaivanan Kanniyan [1]

[1] Asian-Joint Reconstruction Institute (AJRI), SIMS, Chennai, Tamil Nadu, India.

Address of Correspondence:

Dr. Vijay Bose,
Asian-Joint Reconstruction Institute (AJRI), SIMS, Chennai, Tamil Nadu, India.
E-mail: bose5vijay@hotmail.com


Abstract

Total Knee Arthroplasty (TKA), post High Tibial osteotomy (HTO) continues to be an enigma with published reports of both good and suboptimal results in comparison to TKA for osteoarthritis (OA). The surgeons performing HTO must always employ TKR friendly techniques so that it is easy to apply the correct principles while conversion into TKA and have a very good results contradictory to the traditional historical conclusion. The bug bear of HTO is the post slope where common errors can occur even when performed by experienced surgeons. The norm is usually for the post slope to increase with the medial open wedge and for the post slope to decrease with lateral Closed wedge. The golden rule in Post HTO TKA conversion is to start off by resecting less bone. This is done so that inadvertent joint line variation from ideal is avoided. We then do extension space management by using various thickness of spacer hemi blocks. However individual cases may be different. Reliable results can be achieved in post HTO TKR if good planning and careful execution of the potentially problematic steps are undertaken. Residual soft tissue laxity necessitating increased constraint is more common in Post HTO TKR than in TKR for OA.
Keywords: Total Knee Replacement, High Tibial Osteotomy, Osteoarthritis


References

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How to Cite this article: Bose VC, Kanniyan K | Total Knee Replacement After High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 54-57.


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Osteotomy Complications: Prevention and Cure

Volume 6 | Issue 2 | July-December 2021 | Page 46-53 | Ravi T Rudraraju , Jobe Shatrov , Brett A Fritsch

DOI:10.13107/aja.2021.v06i02.034


Author: Ravi T Rudraraju [1], Jobe Shatrov [1], Brett A Fritsch [1]

[1] Department of Orthopaedics, Sydney Orthopaedic Research Institute, Chatswood NSW, Australia.

Address of Correspondence:

Dr. Brett Fritsch,
Orthopaedic Surgeon, Sydney Orthopaedic Research Institute, Chatswood NSW, Australia.
E-mail: brett@brettfritsch.com.au


Abstract

Osteotomies around the knee are done to treat unicompartmental knee osteoarthritis, address instability and to correct the deformity. Careful selection of patient and preoperatively planning the target alignment are the key to achieve optimal results. There are multiple types of osteotomies with varying complication rates for each procedure. Opening wedge high tibial osteotomy (HTO) is the commonly performed osteotomy with an incidence of complications ranging from 1.9% to 55%. Closed wedge HTO has complication rate of around 10 to 34% and higher complication rates (19 to 70%) are reported with distal femoral osteotomy. Complications are broadly classified into general and osteotomy specific complications, and osteotomy specific complications can be further subdivided into failure of effect, complications of the osteotomy itself, and complications of the implant.
This paper presents an overview of the complications of common osteotomies around the knee, predominantly high tibial and distal femoral osteotomy, and the approaches and techniques the surgeon can use to minimise their frequency and severity.
Keywords: High Tibial Osteotomy, Medial Closed Wedge HTO, Lateral Closed Wedge HTO, Distal Femoral Osteotomy, Complications after Osteotomy


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How to Cite this article: Rudraraju RT, Shatrov J, Fritsch BA| Osteotomy Complications: Prevention and Cure | Asian Journal of Arthroscopy | July-December 2021; 6(2): 46-53.


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Lateral Closing-Wedge High Tibial Osteotomy in Unicompartmental Medial Knee Arthritis

Volume 6 | Issue 2 | July-December 2021 | Page 12-19 | Nicolaas C. Budhiparama, Dwikora N. Utomo, Kukuh D. Hernugrahanto

DOI:10.13107/aja.2021.v06i02.029


Author: Nicolaas C. Budhiparama [1, 2, 3], Dwikora N. Utomo [4], Kukuh D. Hernugrahanto [4, 5]

[1] Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Jakarta, Indonesia.
[2] Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
[3] Department of Vocational Studies, University Airlangga, Surabaya, Indonesia.
[4] Department of Orthopedic & Traumatology, Faculty of Medicine, University Airlangga, Indonesia.
[5] Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Address of Correspondence:
Dr. Nicolaas C. Budhiparama,
Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Jakarta, Indonesia.
E-mail: n.c.budhiparama@gmail.com


Abstract

The high tibial osteotomy (HTO) is one attainable management of varus knee osteoarthritis. Particularly aimed at the young and active patient population. This procedure can alleviate the symptoms and restore alignment, which may significantly defer the requirement for knee arthroplasty in the future time. Close-wedge high tibial osteotomy (CW-HTO) is an effective option with minimal complication rate. Choosing between an open-wedge HTO, close-wedge HTO, or unicompartmental knee arthroplasty (UKA) for medial compartmental knee arthritis should be tailored to patients’ preoperative conditions and surgeons’ preferences. There is no clear evidence that one surgical method is superior to the other.

Keywords: High tibial osteotomy, Varus knee osteoarthritis, Medial compartment


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How to Cite this article: Budhiparama NC, Utomo DN, Hernugrahanto KD | Lateral Closing-Wedge High Tibial Osteotomy in Unicompartmental Medial Knee Arthritis | Asian Journal of Arthroscopy | July- December 2021; 6(2): 12-19.


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Planning for a Successful High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 08-11 | Hamid Razak, Kristian Kley
DOI:10.13107/aja.2021.v06i02.028


Author: Hamid Razak [1, 2], Kristian Kley [3, 4]

[1] SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme 20 College Road, Academia Level 4, Singapore 169865.
[2] Department of Orthopaedic Surgery, Sengkang General Hospital 110 Sengkang East Way, Singapore 544886.
[3] London Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne Street, London.
[4] Orthoprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany.

Address of Correspondence:
Dr. Hamid Razak,
Department of Orthopaedic Surgery, Sengkang General Hospital 110 Sengkang East Way, Singapore 544886.
E-mail: hamidrazak@gmail.com


Abstract

High tibial osteotomy (HTO) has been the workhorse joint preserving surgery for medial knee osteoarthritis (KOA) with varus deformity. Its importance as a surgical option has been amplified in recent years due to the greater incidence of KOA in young active patients. HTO procedures produce the best outcomes and the highest predictability when executed according to the pre-ordained surgical plan. Planning for an HTO is a mandatory and critical step. Failure to plan adequately leads to poor outcomes following HTO. Methods of planning can be broadly classified into traditional pen-and-paper planning as well as digital planning with software. Both are acceptable methods with their own merits but their utilization may be influenced by surgeon preferences, accessibility, case load and experience.
keywords: Varus knee osteoarthritis, Knee preservation, High tibial osteotomy, Preoperative planning, Surgical planning


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How to Cite this article: Razak H, Kley K | Indications for High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 08-11.


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Indications for High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 3-7 | Clement Joseph, Yugal Varandani

DOI: 10.13107/aja.2021.v06i02.027


Author: Clement Joseph [1], Yugal Varandani [1]

[1] Department of Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.

Address of Correspondence:
Dr. Clement Joseph,
Senior Consultant & Head, Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.
E-mail: clementorth@yahoo.co.in


Abstract

There is a resurgence of interest in HTO to treat young to middle aged patients with varus alignment and isolated medial joint osteoarthritis. With improvements in implant design and preoperative planning methods, good outcomes are reported in multiple studies. But the most important factor for a successful outcome is patient selection. The ideal patient would be a middle-aged patient with isolated medial joint arthritis with good range of movements, non-smoker and with reasonable functional status of knee. The indications of HTO are evolving to include patients in higher age groups, with minimal to moderate patellofemoral symptoms and varying amounts of flexion deformities. It is also increasingly being performed as a joint protective surgery following meniscus repairs and cartilage repair procedures and to correct abnormal joint alignment following neglected ligamentous injuries.


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How to Cite this article: Joseph C, Varandani Y | Indications for High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 03-07


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