J Korean Orthop Assoc.  2014 Apr;49(2):85-94. 10.4055/jkoa.2014.49.2.85.

Basic Principles and Current Trends of Medial Opening-Wedge High Tibial Osteotomy

• Shin YS
• Lee DH
• Lee SH
• Kim MJ
• Han SB

• KMID: 2185213
• DOI: http://doi.org/10.4055/jkoa.2014.49.2.85

Abstract

High tibial osteotomy (HTO) is a popular surgical procedure for osteoarthritis of the knee with varus deformity. In general, HTO has shown sufficient clinical outcomes with careful patient selection and correct surgical technique. Among various surgical techniques, medial opening-wedge and lateral closing-wedge HTO are widely used. This report includes basic principles and current trends in patient selection and preoperative evaluations and planning, operative technique, complications, and rehabilitation protocol in medial opening-wedge HTO.

Keyword

knee; osteoarthritis; high tibial osteotomy; medial opening-wedge

MeSH Terms

Congenital Abnormalities
Knee
Osteoarthritis
Osteotomy*
Patient Selection
Rehabilitation

Figure

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  Figure 1 Scanography measurement method. A template was cut through the osteotomy site and the tibia was rotated until the weight-bearing line passed through the 62% coordinate.

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  Figure 2 Bilateral weight bearing anteroposterior whole lower limb X-ray in full extension for planning an open wedge high tibial osteotomy. (A) Method by Miniaci (Line 1 represents the planned weight bearing line for the postoperative correction extending from the center of the hip through a coordinate 60%-70% of the tibial plateau width past the ankle. Line 2 connects the osteotomy hinge point with the center of the ankle. Line 3 connects the osteotomy hinge point with the arc intersection of line 1. The angle formed by lines 2 and 3 is the planned correction angle (x)). (B) Method by Dugdale and Noyes (Line 1 is drawn from the center of the femoral head to the 62.5% of the tibial width. Line 2 is drawn from the center of the tibiotalar joint to the 62.5% coordinate. The angle formed by these two lines is the correction angle (x)). (C) Method by Conventry.

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  Figure 3 Anteroposterior radiograph of the knee showing the extent of the safe zone. Between A and B: safe zone. A, tip of the fibular head; B, circumference line of the fibular head.

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  Figure 4 The dorsal cut of the biplanar osteotomy also started 4 cm below the medial joint line. Only the posterior two thirds of the tibia were cut. The frontal third of the tibia was left intact. The anterior cut was aimed at a point 2 cm below the ventral joint line.

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  Figure 5 Clinical picture shows that pes anserinus is pulled distally from its head edge using a hook after separating the subcutaneous tissue and fascia.

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  Figure 6 Clinical photo shows intraoperative finding that the mechanical axis can be evaluated using Bovie line or a measuring tape.

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  Figure 7 Preoperative (A) and postoperative (B) anteroposterior whole lower limb X-ray.

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