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. 2016 Aug 18;4(2):98-110.
doi: 10.11138/jts/2016.4.2.098. eCollection 2016 Apr-Jun.

High tibial osteotomy in varus knees: indications and limits

Marco Corgiat Loia  1 , Stefania Vanni  1 , Federica Rosso  1 , Davide Edoardo Bonasia  1 , Matteo Bruzzone  1 , Federico Dettoni  1 , Roberto Rossi  1
Affiliations

High tibial osteotomy in varus knees: indications and limits

Marco Corgiat Loia et al. Joints. .

Abstract

Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for OWHTO are medial compartment osteoarthritis and varus malalignment of the knee; recently OWHTO has been used successfully in the treatment of double and triple varus. OWHTO, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. The aim of this study is to review the literature on OWHTO, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at mid-term follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty).

Keywords: high tibial osteotomy; knee; opening wedge; osteoarthritis; prognostic factors.

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Figures

Fig. 1
Fig. 1
From a point representing 3° to 5° of mechanical valgus located at 62.5% of the tibial width, a single line is drawn to the center of the femoral head. Another line is drawn from this point to the center of the ankle joint. The angle between the two lines represents the angle of correction (α). The osteotomy line is measured from the medial (about 4 cm below the joint line) to the lateral (tip of the fibular head) side of the proximal tibia. This measurement is transferred to both rays of the α angle from the vertex. The line, b1c corresponds to the opening that should be achieved medially at the osteotomy site.
Fig. 2
Fig. 2
Postoperative X-rays at 3 months: A: AP view of the operated knee; B: lateral view of the operated knee.
Fig. 3
Fig. 3
Vertical gap measurements are functions of the distance from the hinge axis of the lateral tibial cortex (B1, B2), the oblique α angle of the anteromedial tibial cortex, and the distance along the osteotomy L. These functions are L=(B1–B2)COS(α); B2=[(A2)(B1)]/A1.
See this image and copyright information in PMC

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