Osteotomy: The Final Frontier in Knee Preservation

Volume 6 | Issue 2 | July-December 2021 | Page 01-02 | Anshu Shekhar, Sachin Tapasvi

DOI:10.13107/aja.2021.v06i02.026


Author: Anshu Shekhar [1], Sachin Tapasvi [2]

[1] Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
[2] The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Address of Correspondence:

Dr. Anshu Shekhar,
Consultant, Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
E-mail: dr.anshushekhar@gmail.com


Editorial

Asian Journal of Arthroscopy completes 5 years of publication with this issue. This feat could only be achieved because of the unflinching support from all our authors, reviewers and above all, the readers. In all our previous issues, we have dealt with specific areas and pathologies which can be treated by arthroscopy. The knee joint has received most attention because it the most common joint to be injured and be treated as well. However, any
talk of knee preservation is incomplete without acknowledging the art and science of osteotomy. This issue is dedicated to discussing the various aspects of a modern knee osteotomy for preserving the knee joint because it is indeed the final frontier.

Osteotomy surgery is a proven method of knee joint preservation by correcting mal-alignment in the coronal and sagittal planes [1]. It has been used to treat knee osteoarthritis by correcting varus or valgus mal-alignment since a very long time and with good results [2]. However, the science and art of osteotomy has evolved significantly over the last decade or so and everything is not so simple about a high tibial osteotomy (HTO) anymore. This has made osteotomy more predictable and safer, while expanding the indications and applications. One major ‘expanded’ indication has been to use osteotomy to treat ligament instabilities of the knee. This has been a force multiplier for ligament surgeons, who can achieve greater success with their soft-tissue reconstruction [3]. Perhaps the most remarkable progress has been made in planning an osteotomy. The use of digital planning techniques and specialized software for defining the deformity and correction has made osteotomy planning more reproducible and accurate [4, 5]. However, clinical examination cannot be given a miss in spite of any sophisticated radiological planning tool. Assessment of the soft-tissue laxity has to be considered in the surgical plan because this is an important cause of over-correction [6].

Medial open wedge high tibial osteotomy (MOWHTO) remains by far the most commonly performed surgery to correct malalignment around the knee for any indication. A close wedge or dome osteotomy are less frequently performed but have their place. Techniques of these surgeries are also evolving, the most important of which are performing a biplanar osteotomy and use of angle-stable locked plates for fixation. Both these provide definite benefits in terms of biology and biomechanics, thus permitting early mobilization and weight bearing [7, 8]. Another simple but remarkable innovation has been use of a K wire as a hinge protection tool. This has reduced the incidence of lateral hinge fractures by increasing the stiffness of hinge by about 880% and allowing early healing of the osteotomy [9, 10]. Even in cases of varus osteoarthritis with severe deformity, the utility of a double-level osteotomy to prevent joint line obliquity and provide good results has been demonstrated [11]. Another area of interest now are sagittal tibial osteotomies, especially the anterior closing wedge to reduce the posterior tibial slope in the setting of repeated failures of anterior cruciate ligament reconstruction [12].

As regards the use of technology for performing osteotomies, navigation has been used for quite some time. Although navigated HTO has yielded better precision and accuracy of alignment correction, it has not translated to better clinical outcomes [13]. The newest technological marvel in osteotomy surgery is the use of patient-specific cutting jigs and implants. This is a promising new avenue with good clinical results reported in the short-term without an increased risk of specific or non-specific complications [14]. In spite of everything, some patients will eventually require a total knee arthroplasty (TKA) for end-stage disease. The long-term survivorship of a TKA after HTO has been reported as 97% with a 3% revision rate for instability [15]. The survival drops to 88% after a distal femoral osteotomy when 6% revisions are due to instability [16]. These numbers are for patients who underwent osteotomies when the philosophy was still not refined. With better osteotomy technique and respect to ligament balancing, the TKA survivorship should also improve in future.

All these issues related to planning, execution and performance of a knee osteotomy have been dealt with in great detail and up to date information in this issue. We do hope that the wealth of knowledge contributed by the stalwarts of osteotomy surgery will be loved and appreciated by all our readers. The bone always wins and anybody willing to preserve a knee joint must have the weapon of osteotomy in their armamentarium.


References

1. Zampogna B, Vasta S, Papalia R. Patient Evaluation and Indications for Osteotomy Around the Knee. Clin Sports Med. 2019;38(3):305-315. doi:10.1016/j.csm.2019.02.011
2. Peng H, Ou A, Huang X, et al. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021;13(5):1465-1473. doi:10.1111/os.13021
3. Tischer T, Paul J, Pape D, et al. The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence. Orthop J Sports Med. 2017;5(3):2325967117697287. doi:10.1177/2325967117697287
4. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2041-2048. doi:10.1007/s00167-014-2920-x.
5. Schröter S, Ihle C, Mueller J, Lobenhoffer P, Stöckle U, van Heerwaarden R. Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):189-196. doi:10.1007/s00167-012-2114-3
6. Park JG, Kim JM, Lee BS, Lee SM, Kwon OJ, Bin SI. Increased preoperative medial and lateral laxity is a predictor of overcorrection in open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(10):3164-3172. doi:10.1007/s00167-019-05805-8.
7. Pape D, Lorbach O, Schmitz C, et al. Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):204-211. doi:10.1007/s00167-009-0929-3
8. Koh, YG., Lee, JA., Lee, HY. et al. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res 14, 219 (2019). doi.org/10.1186/s13018-019-1269-8.
9. Gulagaci F, Jacquet C, Ehlinger M, et al. A protective hinge wire, intersecting the osteotomy plane, can reduce the occurrence of perioperative hinge fractures in medial opening wedge osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(10):3173-3182. doi:10.1007/s00167-019-05806-7
10. Dessyn E, Sharma A, Donnez M, et al. Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):751-758. doi:10.1007/s00167-019-05404-7
11. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J. Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg. 2019;139(4):519-527. doi:10.1007/s00402-018-3068-9
12. Vadhera AS, Knapik DM, Gursoy S, et al. Current Concepts in Anterior Tibial Closing Wedge Osteotomies for Anterior Cruciate Ligament Deficient Knees. Curr Rev Musculoskelet Med. 2021;14(6):485-492. doi:10.1007/s12178-021-09729-0
13. Wu ZP, Zhang P, Bai JZ, et al. Comparison of navigated and conventional high tibial osteotomy for the treatment of osteoarthritic knees with varus deformity: A meta-analysis. Int J Surg. 2018;55:211-219. doi:10.1016/j.ijsu.2018.03.024
14. Chaouche S, Jacquet C, Fabre-Aubrespy M, et al. Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. Int Orthop. 2019;43(12):2757-2765. doi:10.1007/s00264-019-04372-4
15. Chalmers BP, Limberg AK, Tibbo ME, Perry KI, Pagnano MW, Abdel MP. Total Knee Arthroplasty After High Tibial Osteotomy Results in Excellent Long-Term Survivorship and Clinical Outcomes. J Bone Joint Surg Am. 2019;101(11):970-978. doi:10.2106/JBJS.18.01060
16. Chalmers BP, Limberg AK, Athey AG, Perry KI, Pagnano MW, Abdel MP. Total knee arthroplasty after distal femoral osteotomy long-term survivorship and clinical outcomes. Bone Joint J. 2019;101-B(6):660-666. doi:10.1302/0301-620X.101B6.BJJ-2018-1334.R2


How to Cite this article: Shekhar A, Tapasvi S | Osteotomy: The Final Frontier in Knee Preservation | Asian Journal of Arthroscopy | July-December 2021; 6(2): 01-02.


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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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49. Hankemeier S, Hufner T, Wang G, Kendoff D, Zeichen J, Zheng G, et al. Navigated open-wedge high tibial osteotomy: Advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surgery, Sport Traumatol Arthrosc. 2006 Oct;14(10):917–21.
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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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Sagittal Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 39-45 | Anshu Shekhar, Puneeth K, Sachin Tapasvi

DOI:10.13107/aja.2021.v06i02.033


Author: Anshu Shekhar [1], Puneeth K [2], Sachin Tapasvi [2]

[1] Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
[2] The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Address of Correspondence:

Dr. Anshu Shekhar,
Consultant, Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
E-mail: dr.anshushekhar@gmail.com


Abstract

The anatomy proximal tibia is such that the anterior part is higher than the posterior, both medially and laterally, which causes a natural posterior tibial slope (PTS). The ‘normal range’ of this slope is variable across geography, ethnicity and gender. The morphology of the slope has profound impact on knee biomechanics, especially with respect to the anterior and posterior cruciate ligaments. A high slope increases forces across the anterior cruciate ligament (ACL), while the posterior cruciate ligament (PCL) function is compromised when the slope is flat or reversed (sloping anteriorly). A flat or reversed slope also contributes to the ‘bony’ component of a genu recurvatum deformity, which can become symptomatic. A sagittal tibial osteotomy (STO) is one in which the PTS is altered without changing the coronal plane alignment. When the slope is reduced, it is known as an extension STO and when the slope is increased, it is known as a flexion STO. This review describes the biomechanics of the PTS; the planning, indications, technique and complications of a STO and discusses some case examples.

Keywords: Posterior tibial slope, Osteotomy, Sagittal plane deformity, Revision anterior cruciate ligament reconstruction, Genu recurvatum


References

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12. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376-382. doi:10.1177/0363546503258880

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14. Bernhardson AS, Aman ZS, Dornan GJ, Kemler BR, Storaci HW, Brady AW, Nakama GY, LaPrade RF. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019 Feb;47(2):296-302.

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20. Utzschneider S, Goettinger M, Weber P, et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 2011;19:1643-1648.

21. Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res. 2009 Aug;467(8):2066-72.

22. Luceri F, Basilico M, Batailler C, et al. Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height. Int Orthop. 2020;44(11):2291-2298. doi:10.1007/s00264-020-04580-3

23. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013 Dec;41(12):2800-4.

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How to Cite this article: Shekhar A, Puneeth K, Tapasvi S | Sagittal tibial osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 39-45.


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Patient Specific Instrumentation in Knee Osteotomies

Volume 6 | Issue 2 | July-December 2021 | Page 34-38 | Matthieu Ollivier, Christophe Jacquet, Grégoire Micicoi

DOI:10.13107/aja.2021.v06i02.032


Author: Matthieu Ollivier [1], Christophe Jacquet [2], Grégoire Micicoi [3]

[1] Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France.
[2] Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France.
[3] iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d’Azur, Nice, France

Address of Correspondence:

Dr. Matthieu Ollivier,
Institute of Movement and Locomotion Department of Orthopaedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France.
E-mail: matthieu.ollivier@ap-hm.fr


Abstract

Knee osteotomy is a successful operation which allow restoration of function, the preoperative planning and the achievement of the target correction during the surgery constitute critical steps which may affect the clinical results. With conventional techniques, the target correction may be difficult to obtain with substantial under- or overcorrection, then the preoperative planning should not only take into account the global alignment but also the segmental deformities with the proximal tibial deformity, the distal femoral deformity and the intra-articular deformity requiring an individualised approach to obtain the intended correction. The recent introduction of patient-specific cutting guides (PSCGs) based on preoperative CT-scan templating now offers the possibility of providing an instrumentation specific to each patient allowing to control exactly the correction in the different planes. The recent expansion in the use of PSCGs within the surgical community allows us to explore all its fields of application, from the simplest cases to the most complex cases. The accuracy of these guides allows in practice a great reliability for which the clinical impact must be known. However, we must keep in mind that the surgeon makes the final decision on target correction and this, whatever the level of accuracy of the tool used which involves that errors can occur in the event of poor preoperative analysis. The advantages and disadvantages of PSCGs require special consideration to justify their use.
Keywords: Knee osteotomy, Patient-specific cutting guide, Accuracy, Individualised approach, Correction


References

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How to Cite this article: Ollivier M, Jacquet C, Micicoi G Patient Specific | Instrumentation in Knee Osteotomies | Asian Journal of Arthroscopy | July-December 2021; 6(2): 34-38.


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Double Level Osteotomy of the Knee for Varus Osteoarthritis

Volume 6 | Issue 2 | July-December 2021 | Page 27-33 | Sam Trowbridge, Hamid Razak, Dominic Davenport, Philip Pastides, Kristian Kley, Matthieu Ollivier, Raghbir S Khakha, Adrian J Wilson

DOI:10.13107/aja.2021.v06i02.031


Author: Sam Trowbridge [1], Hamid Razak [2, 3], Dominic Davenport [4], Philip Pastides [1], Kristian Kley [7], Matthieu Ollivier [5, 6], Raghbir S Khakha [1], Adrian J Wilson [7]

[1] Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
[2] Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore 544886.
[3] SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, Singapore 1698.
[4] Consultant Trauma & Orthopaedic Surgeon, Princess Royal University Hospital, Bromley, London.
[5] Institute of movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France,
[6] Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
[7] Harley Street Specialist Hospital, 18-22 Queen Anne Street, London W1G 8HU.

Address of Correspondence:

Dr. Raghbir S Khakha,
Consultant, Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
E-mail: raghbir.khakha@gmail.com


Abstract

High tibial osteotomy (HTO) has been a well accepted surgical procedure for knees with varus knee osteoarthritis. It is an excellent option for patients who are younger and have higher functional demands. However, correction of a severe varus knee by isolated (HTO) would require a significant opening which will invariably lead to joint line obliquity ( JLO) and increase the risk of complications such as hinge fractures. As such, double level osteotomy (DLO) consisting of a HTO and distal femoral osteotomy (DFO) has been purported as the preferred joint preserving procedure in patients with severe varus deformity. DLO is able to restore the mechanical alignment of the limb without causing JLO. In this narrative review, we explore the pathomechanics of varus osteoarthritis, surgical considerations for DLO planning, indications, outcomes and complications of DLO. We have also presented our preferred approach for DLO.


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How to Cite this article: Trowbridge S, Razak A, Davenport D, Pastides P, Kley K, Ollivier M, Khakha RS, Wilson AJ Double Level Osteotomy of the Knee | for Varus Osteoarthritis | Asian Journal Arthroscopy | July-December 2021; 6(2): 27-33.


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Opening Wedge High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 20-26 | Parag Sancheti, Sunny Gugale, Kailash Patil, Ashok Shaym

DOI:10.13107/aja.2021.v06i02.030


Author: Parag Sancheti [1], Sunny Gugale [1], Kailash Patil [1], Ashok Shaym [1, 2]

[1] Department of Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation & PG College, Pune, Maharashtra, India.
[2] Indian Orthopaedic Research Group, Thane, Maharashtra, India.

Address of Correspondence:

Dr. Parag Sancheti,
Dean, Professor & Chairman, Sancheti Institute for Orthopaedics & Rehabilitation & PG College, Pune, Maharashtra, India.
E-mail: sanchetipk@gmail.com


Abstract

In the era of Joint replacement surgery, Medial High Tibial Osteotomy is a time tested and successful surgical procedure for treatment of mild to moderate knee osteoarthritis. The success of this procedure lies in proper patient selection, an excellent surgical technique, a rigid internal fixation and early rehabilitation. There are a lots of research articles published in literature, many systematic reviews and meta-analysis on this specific topic. In this review article we discuss mainly the recent trends in the medial open wedge osteotomy for treatment of knee osteoarthritis.

Keywords: MOWHTO, Osteoarthritis, Osteotomy, Surgical treatment


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How to Cite this article: Sancheti P, Gugale S, Patil K, Shaym A | Opening wedge high tibial osteotomy | Asian Journal Arthroscopy | July-December 2021; 6(2): 20-26.


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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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