Anterior Proximal-to-Posterior Distal Oblique Proximal Tibial Osteotomy

Abstract

High tibial osteotomy (HTO) is a common orthopedic procedure [1–3], which includes medial open wedge osteotomy, lateral closed wedge osteotomy, arch osteotomy, and oblique osteotomy, of which the former two techniques are the most used [4]. However, both techniques are disadvantageous to correcting a severe deformity because, in that case, enormous bone grafting is required in medial open wedge osteotomy, there is a high possibility of nonunion and correction loss, and enormous tibial height loss is inevitable in lateral close wedge osteotomy. Posterior proximal-to-anterior distal oblique proximal tibial osteotomy (PTO) has been reported but seldom used in large series. The main disadvantage is that the osteotomy site of the posterior tibial cortex is too close to the joint line and a high risk of the posterior neurovascular structure injury [5]. Polyzois et al. reported a slightly anterior proximal-to-posterior distal (AP-PD) oblique HTO, which we consider suitable for minor deformity correction [6]. Thus, we would like to introduce an AP-PD oblique PTO technique to address the need for a great deformity correction and decrease the risk of posterior neurovascular injury. The main indication of this technique is medial compartment osteoarthritis with varus knee caused mainly by tibial deformity (Table 59.1).