In general, published studies on hto report good longterm results with a correct patient selection and a precise surgical technique. They are usually done to correct a knockkneed alignment. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary. Opening wedge high tibial osteotomy is a good option in highly active patients with varus gonarthrosis who would like to delay or prevent progression to total knee arthroplasty without activity. Opening wedge osteotomy in the medial proximal tibia is used as an alternative to the traditional method of lateral closing wedge osteotomy. High tibial valgus osteotomy hto is an established surgical procedure to correct varus malalignment in patients with medialcompartment osteoarthritis oa of the knee. This video simply explains the logic and the technique of the open wedge high tibial osteotomy. This video elucidates a closing wedge osteotomy of the distal femur. Medial opening wedge proximal tibial osteotomy is an effective procedure for restoring proper coronal alignment and reducing knee pain. Total knee arthroplasty after high tibial osteotomy.
Longterm survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. A closing wedge osteotomy is where the bone is cut twice and the wedge removed. High tibial osteotomy atlanta closing wedge osteotomy. Medial closing wedge distal femur varization osteotomy. Closed wedge high tibial osteotomy is the traditional method to treat medial osteoarthritis of the knee. Osteotomies of the thighbone femur are done using the same technique.
Both techniques provide good outcomes with decreased pain and improved function. Nowadays it is peformed less frequently because of the increasing importance of open wedge osteotomy. Patients are randomized to undergo a high tibial osteotomy, with either a lateral closing wedge technique or a combined wedge osteotomy technique. Hto lateral closing wedge ap 1 hto lateral closing wedge 2 hto lateral closing wedge. This is a presentation of a medial opening wedge tibial osteotomy for isolated medial compartment osteoarthritis in a 52. The lateral closing wedge technique is a primary stable correction with a high rate of consolidation, but has the disadvantage of bone loss and change in tibial condylar offset. Objective to describe a surgical technique, and outcome, for treatment of cranial cruciate ligament crcl deficient stifle joints with excessive tibial plateau angle tpa by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy tploccwo. In this technical note, we present a reproducible technique for proximal tibial osteotomy. Closing versus opening wedge high tibial osteotomy. Jackson is credited being the first in the englishlanguage literature to report performing aproximal high tibial osteotomy hto to treatosteoarthritis of the knee. High tibial osteotomy mechanical axis tibiofemoral angle proximal tibial osteotom tibial head. Modified cranial closing wedge osteotomy for treatment of. The closing wedge technique, as popularised by coventry 9, involves an osteotomy above the tibial tubercle and removal of a wedge of bone. First, the slopedecreasing anterior closing wedge tibial osteotomy and revision acl.
In the treatment of lower extremity malalignment and osteoarthritis, high tibial osteotomy is a procedure that allows for the realignment of the lower extremity and thereby either shifts the weightbearing access to the healthier portion of the knee or corrects the alignment deformity. The image on the right is that of a closing wedge osteotomy and is reproduced with the permission of synthes. Increased tibial slope can be a cause of recurrent instability after anterior cruciate ligament reconstruction. High tibial osteotomy hto for bow leg correction duration. Closing wedge osteotomy is the most commonly used technique to perform high tibial osteotomy. 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 opening wedge osteotomy also allows the opening wedge high tibial osteotomy an operative technique and rehabilitation program to decrease. Filling of the osteotomy gap with autogenous cancellous bone, if the opening is mm. Angular deformity in the knee leads to abnormal distribution of weight bearing stresses. Tibial slope correction combined with second revision acl produces good knee stability and prevents graft rupture. This manipulation brings the bones together and fills the space left by the removed bone. Technical pearls in open wedge high tibial osteotomy, avoiding complicat. High tibial osteotomy open wedge technique the real.
Reports are conflicting which procedure is preferred. There has been a shift towards opening wedge techniques partially due a perceived higher complication rate with closing wedge techniques. Lateral closing wedge osteotomy is effective for correction near maximal point of deformity. Anterior closing wedge proximal tibial osteotomy for slope. Our elearning platform contains high resolution images and a certified cme of the high tibial osteotomy synthes tomofix plate surgical procedure. Opening wedge and closing wedge osteotomy kneeguru. Anterior closing wedge tibial osteotomy for failed. Valgusproducing high tibial osteotomy hto is a wellaccepted treatment modality. Anterior closingwedge osteotomy for posterior slope.
A novel closedwedge high tibial osteotomy procedure to treat osteoarthritis of the knee. Planning of opening wedge high tibial osteotomy left knee, anteroposterior view. Various high tibial osteotomy techniques are currently used to this end. High tibial closing wedge osteotomy for medial compartment. While it has been reported that the results of tka following hto are worse than those in patients without prior knee surgery, the influence of osteotomy technique medial opening wedge versus lateral closing. Osteotomy of the proximal tibia has been used formore than a century to correct angular deformityin the setting of rickets, poliomyelitis, andposttraumatic conditions. The lateral closing wedge technique is a primary stable correction with a high rate of consolidation, but has the disadvantage of bone loss and. Complications of closing wedge high tibial osteotomy. High tibial osteotomy hto is a common and widely accepted procedure in orthopaedic surgery. The reported advantages of this technique include better initial stability due to the compressive nature of the osteotomy leading to more immediate weight. Opening wedge high tibial osteotomy and anterior cruciate. High tibial osteotomy synthes tomofix plate surgical. Operation related complications are minimal and avoidable.
Closingwedge high tibial osteotomy with a modified weber. High tibial osteotomy hto predominately done for varus deformities. The closing wedge is still worldwide the most commonly performed high tibial osteotomy hto. Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. An anterior closing wedge osteotomy to reduce posterior tibial slope has been shown to be an effective procedure to reduce the risk of aclr graft failure in clinical studies 4 x 4 dejour, d. High tibial osteotomy hto for bow leg correction youtube. Closing wedge high tibial osteotomy for medial compartment osteoarthritis high tibial osteotomy is an effective treatment for mild to moderate medial compartment osteoarthritis of the knee in physiologically young and active people. The most common indication for lateral closing wedge tibial osteotomies is unicompartmental varus knee gonarthrosis with a wellmaintained range of motion of at least 90 degrees of flexion and less than 15 degrees of flexion contracture with varus tibialfemoral malalignment 3, 5, 7, 8, 10, 17, 2730. While it has been reported that the results of tka following hto are worse than those in patients without prior knee surgery, the influence of osteotomy technique medial opening wedge versus lateral closing wedge has not been. Complications of closing wedge high tibial osteotomy ncbi. Lateral openingwedge high tibial osteotomy request pdf. High tibial osteotomy hto is a widely accepted procedure to treat medial knee. The closing wedge technique, as popularised by coventry, involves an osteotomy above the tibial tubercle and removal of a wedge of bone laterally in order to realign the knee into valgus to offload the medial compartment thus relieving the symptoms of medial compartment osteoarthrosis thereby improving function. We present the technical procedure including a corresponding case report.
Nevertheless, there are indications in which the classic technique should be preferred. A opening wedge high tibial osteotomy is planned with a line from point y 62. Closing versus opening wedge high tibial osteotomy vumedi. This article presents a technique for an anterior closing wedge osteotomy for slope correction. Closing wedge osteotomy of the tibia and the femur in the. A closing wedge osteotomy with the technique as described by gross and hutchinson 4 will produce a tibiofemoral angle of 0 degrees. Complications of closing wedge high tibial osteotomies for unicompartmental osteoarthritis of the knee. High tibial osteotomy hto is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty tka. Two basic hto techniques are commonly performed, a lateral closingwedge hto and a medial openingwedge hto. Combination tibial plateau leveling osteotomy and cranial. Closing wedge osteotomy a closing wedge osteotomy is where the bone is cut twice and the wedge removed. Surgeons can perform the high tibial osteotomy using a variety of techniques, predominantly opening wedge and closing wedge6. Proper surgical techniques are very important, and lateral closing wedge. A novel closedwedge high tibial osteotomy procedure to.
Survival of opening versus closing wedge high tibial osteotomy. Common procedures are medial opening wedge and lateral closing wedge tibial osteotomies. Pdf total knee arthroplasty after high tibial osteotomy. Differences between openwedge versus closedwedge high tibial. Rudan, md, frcsc closing wedge high tibial osteotomy for medial compartment osteoarthritis high tibial osteotomy is an effective treatment for mild to moderate medial compartment osteoarthritis of the knee in physiologically young and active people. The reported advantages of this technique include better initial stability due to the compressive nature of the osteotomy leading to more immediate weight bearing and quicker healing. 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. The skin incision was oblique, on the anterolateral side of the tibia, 1 cm above the anterior tibial tuberosity and 1 cm under the fibular head. High tibial osteotomy hto is frequently used to treat varus osteoarthritis oa in younger patients with the goal of delaying the need for total knee arthroplasty tka. A novel closedwedge high tibial osteotomy procedure to treat. Lateral closing wedge osteotomy musculoskeletal key.
The indications for this procedure are patients with recurrent instability after anterior cruciate ligament reconstruction with a neutral leg axis or slightly varus deformity and a. This is the result because the 90degree blade plate is positioned parallel to the articular surfaces and the fragment is closed down until the plate portion fits to the femoral cortex, always producing a tibiofemoral axis of 0 degrees. Medial unicompartmental osteoarthritis with primarily medial compartment pain associated with mild to moderate varus deformity. Correction of the same by osteotomy of shaft of middle phalynx is shown. Results between october 2000 and november 2003, an open wedge high tibial osteotomy stabilized medially.
High tibial osteotomy hto is a widely performed procedure to treat medial knee arthrosis. Tibial osteotomy was first performed in europe in the late 1950s and brought to the united states in the 1960s. It is optimal for patients younger than 55 with a high activity level. Tibial bone transport over an intramedullary nail using cable and pulleys duration.
This procedure is sometimes called a high tibial osteotomy. Opening wedge high tibial osteotomy owhto is widely used to treat unicompartmental osteoarthritis of the knee caused by degenerative deformations of the anatomical axes of the leg. The technique allows rapid bone union due to the large contact surface. The indications for this procedure are being broadened as the need to treat more active patients with arthrosis and malalignment.
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