The Hip: Preservation, Replacement and Revision

Indications and Contraindications: for HTO

- Age:
     - physiologic age < 60 yrs in an athlete, laborer, or anyone who needs to knee down such as for gardening (remember that a TKR will 
            generally not allow the patient to kneel);

- Angular Deformity:
     - less than 15 deg of fixed varus deformity (often patients will have varus laxity);
     - no more than 15 degrees flexion contracture
     - valgus deformities:
            - valgus of upto 12 deg can be corrected by tibial osteotomy;
            - in active pt w/ isolated lateral compartment OA & valgus knee, either HTO or distal femoral osteotomy can relieve symptoms.
            - for valgus deformities > 12 deg, distal femoral osteotomy is preferred in order to maintain joint line parallel to floor.
            - distal femoral osteotomy avoids excessive joint line obliquity.

- Flexion:
     - less than 90 degrees flexion is a contraindication to HTO;

- Tibial Subluxation / Varus Thrust:
     - lateral tibial subluxation more than 1 cm is a contraindication
     - instability in full extension makes it difficult to obtain correct position by tibial osteotomy, and in these cases joint replacement is required;
     - note that a large varus thrust can still place a knee into a relative varus during ambulation (eventhough w/ operative correction into 

- Abduction:
     - when performing either a varus or valgus osteotomy, compensatory arc of motion must be present before surgery.
     - for a 20-degree varus osteotomy, 20 deg of abduction is required so pt does not end up with an adduction deformity.

- Other Conditions:
     - contraindicated w/ RA, inflammatory arthritis, chondrocalcinosis;
     - preop pain in knee w/ pt is at rest should be minimum, since pain at rest may indicate that there is an inflammatory component to dz;
     - ACL tear is a relative contra-indication;
     - osteochondral injuries:
           - w/ involvement of more than 1/3 the condylar surface or OCD lesion of more than 5 mm deep, osteotomy alone may not be 
                  sufficient to restore adequate function to the knee (in these cases consider allografting);
- Tenderness:
     - valgus osteotomy of prox tibia is indicated w/ medial tenderness only;
     - pain should be relieved by rest;

- Arthroscopic Findings:

- Radiographs for HTO:

- Weight:
     - pts who weigh 80 kg are at increased risk for component failure

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

Last updated by Data Trace Staff on Tuesday, August 30, 2011 2:50 pm