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
References
1. Smith JO, Wilson AJ, Thomas NP. Osteotomy around the knee: evolution, principles and results. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):3-22.2. Niinimäki TT, Eskelinen A, Ohtonen P, Junnila M, Leppilahti J. Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: a 22-year population-based study. Int Orthop. 2012;36(7):1399-402.
3. Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424-30.
4. El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG. Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics. 2011;34(10):e622-8.
5. Razak H, Micicoi G, Khakha RS, Ehlinger M, Faizan A, LiArno S, et al. Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees. Knee Surg Sports Traumatol Arthrosc. 2021.
6. Engel GM, Lippert FG, 3rd. Valgus tibial osteotomy: avoiding the pitfalls. Clin Orthop Relat Res. 1981(160):137-43.
7. Kettelkamp DB, Wenger DR, Chao EY, Thompson C. Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. J Bone Joint Surg Am. 1976;58(7):952-60.
8. Tjörnstrand B, Selvik G, Egund N, Lindstrand A. Roentgen stereophotogrammetry in high tibial osteotomy for gonarthrosis. Arch Orthop Trauma Surg. 1981;99(2):73-81.
9. Majeed H. Litigations in trauma and orthopaedic surgery: analysis and outcomes of medicolegal claims during the last 10 years in the United Kingdom National Health Service. EFORT Open Rev. 2021;6(3):152-9.
10. Al Ghunimat A, Hind J, Abouelela A, Sidhu GAS, Lacon A, Ashwood N. Communication With Patients Before an Operation: Their Preferences on Method of Communication. Cureus. 2020;12(11):e11431-e.
11. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res. 1989(246):250-9.
12. Fick R. Handbuch der Anatomie und Mechanik der Gelenke: T. Spezielle Gelenk-und Muskelmechanik: G. Fischer; 1911.
13. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.
14. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res. 1992(274):248-64.
15. Lee SS, Lee HI, Cho ST, Cho JH. Comparison of the outcomes between two different target points after open wedge high tibial osteotomy: The Fujisawa point versus the lateral tibial spine. Knee. 2020;27(3):915-22.
16. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94.
17. Jacobi M, Wahl P, Jakob RP. Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):200-3.
18. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW. A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):90-5.
19. Nakamura R, Komatsu N, Fujita K, Kuroda K, Takahashi M, Omi R, et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J. 2017;99-b(10):1313-8.
20. Sivertsen EA, Vik J, Meland ASV, Nerhus TK. The Dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the Miniaci method. Knee Surg Sports Traumatol Arthrosc. 2021.
21. 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):2041-8.
22. Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy. Knee Surg Relat Res. 2016;28(4):283-8.
| 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. |
