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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 
             valgus);

- 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