Hemi-high tibial osteotomy: technical note and case report

Abstract

High tibial osteotomy (HTO) is a widely performed procedure, with several surgical techniques described to treat varus mal-alignment and medial compartment arthrosis of the knee. In our case report, we present a new surgical technique for performing a medial open wedge HTO in a young patient with proximal varus deformity of the right knee to avoid the clinical complications of HTO. A longitudinal medial incision was made medially over the proximal tibia, the medial collateral ligament (MCL) split, and an osteotomy was made from the medial cortex exiting into the “lateral tibial spine”. The osteotomy was then opened. A wedge measured 12.5 mm, and a bone graft harvested from the right iliac crest was used to fill the defect, followed by a Puddu plate placement. We had planned to have the osteotomy exit in the centre of the knee. Two years postoperatively, complete osteotomy healing and full range of right knee movement with no pain were observed. Radiographs confirmed deformity correction. Many surgical techniques have been described for HTO, including closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, progressive callus distraction, and chevron osteotomy. We believe that in this technique, the risk of nonunion is less, the construct is more stable, and the patient will have a faster rehabilitation program with early weight-bearing. Hemi-HTO is a new surgical technique that can be used to treat proximal varus deformity of the knee, especially if the lateral tibial plateau appears radiologically normal.