Opening Wedge High Tibial Osteotomy

- Discussion:
    - surgical descision making:
             - Limb Alignment After Open-wedge High Tibial Osteotomy and Its Effect on the Clinical Outcome
             - Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust.
             - The effect of a proximal tibial medial opening wedge osteotomy on posterolateral knee instability: a biomechanical study.

- Osteotomy Options:
    - exposure:
          - sartorius fascia is incised and the pes anserinus retracted distally with a blunt retractor, exposing the superficial MCL; 
     - release of MCL: 
          - long fibers of MCL are mobilized and partially released distally to allow a blunt Hohmann retractor to be placed behind the  
                   posteromedial aspect of the tibia to protect the neurovascular bundle;
                 - release of distal fibers also prevents excessive medial compartment loading as the tibia is hinged into valgus;
     - protection of N/V bundle:
           - blunt retractor is passed deep to the MCL to protect the posterior neurovascular structures;
          - ref: The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study
    - standard osteotomy:
          - two 2.5-mm threaded Kirschner wires mark the oblique osteotomy 5 cm distal to the joint line, starting proximal to the pes
                  anserinus and extending to the  level of the tip of the fibula at the lateral cortex
          - saggital plane (lateral view on flouro)
                  - osteotomy is performed parallel to the posterior tibial slope
          - 2.5-mm K wire marks oblique osteotomy 5 cm distal to joint line, starting proximal to pes anserinus and extending to level
                  of tip of fibula at lateral cortex;
          - starting point for opening the osteotomy is posterior to the superficial medial collateral ligament
                  - start at anteromedial tibia at the level of the superior border of the tibial tubercle (approximately 4 cm distal from the joint
                             line) and aiming the tip of the fibular head (approximately 1 cm below the lateral articular surface)
          - medial border of the patellar tendon was identified, retracted, and protected throughout the whole procedure.
          - latearl cortex: careful not to disrupt the lateral cortex;
                      - mobility of the osteotomy is checked by gentle manipulation of the leg with valgus force.
                      - references:
                             - The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. 
                             - Open-wedge high tibial osteotomy: a technical trick to avoid loss of reduction of the opposite cortex
                             - The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy

    - V shaped osteotomy:
             - oblique osteotomy is performed in the posterior two-thirds of the medial aspect of the tibia distal to the Kirschner wires and
                      parallel to tibial slope extending to the tip of the fibula, leaving a 10-mm lateral bone bridge intact;
                      - second osteotomy starts in the anterior one-third of the tibia at an angle of 135°, leaving the tibial tuberosity intact
    - References:
             - Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique 
             - Patellar height relevance in opening-wedge high tibial osteotomy.
             - Modified Retro-Tubercle Opening-Wedge Versus Conventional High Tibial Osteotomy

- Implants:
        - Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate: Surgical Technique
        - Opening-Wedge High Tibial Osteotomy: Review of 100 Consecutive Cases.
 
- Bone Grafting:
       - Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft.
       - Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee 
       - Adverse Event Rates and Classifications in Medial Opening Wedge High Tibial Osteotomy

- Post Operative Care:
    - Early full weight bearing is safe in open-wedge high tibial osteotomy.
    - Medial Opening Wedge High Tibial Osteotomy With Early Full Weight Bearing


- References:

Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies.
Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 12, 2017 7:21 am