Planning of High Tibial Osteotomy

Abstract

Introduction:High Tibial Osteotomy (HTO) is an establish technique for the treatment of varus malaligned knees. The aim of HTO is to reduce the load on the medial compartment by shifting the mechanical axis toward the lateral compartment. It is indisputable that appropriate patient selection, precise surgical planning, and correct operative techniques can provide favorable treatment outcomes of HTO.Method:Case Series. We reported four cases of HTO during clinical attachment in Gleneagles Hospital Kuala Lumpur Malaysia. Two cases are simple Open Wedge HTO, and two cases are Open Wedge HTO that performed simultaneously with posterolateral corner reconstruction. The assessment of lower limb alignment is based on an examination of clinical assessment and full standing radiographs, andplanned correction was achieved when the weight-bearing line passedthrough a target point located at 62% (Fujisawa point) ofthe tibial plateau width measured from themedial border of the tibial plateau.Result:We performed 90, 110, and 60 corrections to shift the weight bearing area to Fujisawa point. Post operative radiologic measurement shown all patients had a good alignment with 60, 50, and 60 valgus over correction, and with insignificant change of tibial slope. PLC instability was reconstruct with modified Larson’s technique by using semitendinous graft. In these cases, we used Tomifix plate (Sythes, Switzerland) as a bridging internal fixation with the principle of a locking compression plate (LCP), and ChronOS (Sythes, Switzerland) as a bone void filler.Conclusion:To achieve good results with HTO requires proper patient selection, good surgical planning, accurate surgical technique, and discipline rehabilitation. Reconstruction of the ligament abnormalities that affect the stability around the knee joint is necessary to achieve better results.