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HIGH TIBIAL OSTEOTOMY
14
Complications
- Recurrence of deformity
- Peroneal
- Nerve palsy
- Nonunion or Malunion
- Infection
- Knee stiffness or instability
- Intraarticular fracture
- Deep vein thrombosis
- Compartment syndrome
Techniques
Closing Wedge Osteotomy
Barrel vault osteotomy of Maquet
- Proximal to the tibial tuberosity
-Lateral app. for varus Vs Medial app. for valgus
-Disruption of the proximal tibiofibular joint
OPENING WEDGE OSTEOTOMY
-More precise
-Requires graft
-Affected limb 2cm shorter
-Recommended when laxity of the medial collateral ligament or combined anterior cruciate ligament deficiency.
-Posterolateral corner instability
Valgus-Producing
- Done for varus knee
- overcorrection of the anatomical axis to 8-10 degrees of valgus
Varus-Producing
- Done for valgus knee
- maintain joint line perpendicular to mechanical axis
Pre-Operative Assessment
History
Physical Examination
- Age
- Career
- Level of Activity
- Previous histury of surgery on the knee
- Expectation
- Smoking
- ROM
- Degree of Deformity
- Ligamentous Instability
- Compensatory Arc of Motion
- Hip Joint and Hip Abductors
- Foot and Ankle
- Leg Length Descrepancy
Radiology
Indications
(1)Pain and disability interfering with ADL
(2) Evidence on weight-bearing radiographs.
(3) Young, active patient, <50 years
Contraindications
(1) narrowing of lateral compartment cartilage space
(2) lateral tibial subluxation of more than 1 cm
(3) medial compartment tibial bone loss of more than 2 or 3 mm
(4) flexion contracture of more than 15 degrees
(5) knee flexion of less than 90 degrees
(6) more than 20 degrees of correction needed
(7) inflammatory arthritis
(8) significant peripheral vascular disease.
(9) BMI > 40
Anatomy
Axis
Biomechanics
Objectives
Techniques
-Varus-Producing
-Valgus-Producing
-General Indications
-Contraindications
-Complications
-History
-Goals
-Presentation
-Anatomy
Goals
Prognosis
History
1- Reduce knee pain
2- Delay or avoid the need for TKR
1961 :JACKSON AND WAUGH FIRST TIBIAL OST.
1965 COVENTRY M.B.
1976 MAQUET DOME OST.
87% in 10 years for the varus-producing
50-85% in the valgus producing
HIGH TIBIAL OSTEOTOMY
By Khalid W. Altabash
Supervised by Dr. Ahmed Tantawy
References
- CAMPBELL’S OPERATIVE ORTHOPAEDICS 12th ed.
- Knee Surg Relat Res. 2012 Jun;24(2):61-69. English. Published online May 31, 2012.
- Wheeless' Textbook of Orthopaedics
Based on Jim Harvey's speech structures
-Knee X-rays:
- Standing AP, lateral, skyline, tunnel view and rosenberg view
-Full length
-MRI