High Tibial Osteotomy: Review of Techniques and Biomechanics.

Xiaoyu Liu,Jing Zhang,Zhongmin Jin,Zhenxian Chen,Yongchang Gao

doi:10.1155/2019/8363128

Abstract

High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. HTO produces a postoperative valgus limb alignment with shifting the load-bearing axis of the lower limb laterally. However, maximizing procedural success and postoperative knee function still possess many difficulties. The key to improve the postoperative satisfaction and long-term survival is the understanding of the vital biomechanics of HTO in essence. This review article discussed the alignment principles, surgical technique, and fixation plate of HTO as well as the postoperative gait, musculoskeletal dynamics, and contact mechanics of the knee joint. We aimed to highlight the recent findings and progresses on the biomechanics of HTO. The biomechanical studies on HTO are still insufficient in the areas of gait analysis, joint kinematics, and joint contact mechanics. Combining musculoskeletal dynamics modelling and finite element analysis will help comprehensively understand in vivo patient-specific biomechanics after HTO.

Highlights

Knee joint is a very complex and important joint for load and motion, including the tibiofemoral (TF) joint and the patellofemoral (PF) joint. e stability of the knee joint is mainly dependent on the interaction by ligamentous and cartilaginous structures, meniscus as well as several muscles and tendons
Knee joint loading and kinematics have been found to be altered in patients with early knee OA during gait [10]
Compared to medial unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), active and demanding activities seem more unlikely after total knee arthroplasty (TKA) [14, 15]

Summary

Introduction

Knee joint is a very complex and important joint for load and motion, including the tibiofemoral (TF) joint and the patellofemoral (PF) joint. e stability of the knee joint is mainly dependent on the interaction by ligamentous and cartilaginous structures, meniscus as well as several muscles and tendons. En seven papers about the comparative studies between HTO and UKA or TKA were included. No conclusive evidences have been con rmed in many previous studies on the e ectiveness of any braces and orthoses for patients with medial knee osteoarthritis [12]. Compared to medial unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), active and demanding activities seem more unlikely after TKA [14, 15]. There are no signi cant di erences in the clinical outcome between UKA and HTO at 12 months and 2-year follow-up, the advantages of HTO is the preservation of the knee joint as long as possible, a large corrective e ect of the mechanical axis, and the avoidance or postponement of knee replacement [17,18,19]. With the improvements in softtissue preparation, advances in surgical techniques, neither the patients’ weight and age nor the genesis of deformity has been found to in uence the rate of complication from a large number of postoperative databases [24,25,26]

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