J Korean Orthop Assoc.  2018 Aug;53(4):293-300. 10.4055/jkoa.2018.53.4.293.

Opening Wedge High Tibia Osteotomy

• Oh SM
• Nha KW
• Han JH

• KMID: 2419464
• DOI: http://doi.org/10.4055/jkoa.2018.53.4.293

Abstract

Proximal tibial osteotomy is the preferred method for treating medial compartment knee arthritis with varus deformity. The purpose of this treatment is to reduce the weight burden of the lesion by correcting the mechanical axis of the patient with degenerative arthritis of medial tibiofemoral joint and abnormal alignment. In general, the proximal tibial osteotomy provides satisfactory clinical results when suitable patient are selected by considering the extent of cartilaginous injury and the age of the patient and the correct technique is performed. In tibial osteotomy, medial open wedge osteotomy is used widely because of its short operation time and relatively simple technique. This review describes the current knowledge of patient selection, preoperative evaluation and planning, treatment principles, surgical techniques, rehabilitation procedures and complications in open wedge high tibial osteotomy.

Keyword

knee joint; osteoarthritis; high tibial osteotomy; medial opening wedge

MeSH Terms

Arthritis
Congenital Abnormalities
Humans
Joints
Knee
Knee Joint
Methods
Osteoarthritis
Osteotomy*
Patient Selection
Rehabilitation
Tibia*

Figure

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  Figure 1 Intraoperative C-arm method. Check whether the mechanical axis is located at 62% to 65% of the outer side of the articular surface using iron or steel tape.

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  Figure 2 Bilateral weight bearing anteroposterior whole lower limb X-ray. (A) Miniaci method. A new mechanical axis Line 1 passing through the desired position is drawn and the angle formed by line 2 and 3 passing through the hinge section (X) is defined as the correcting angle. (B) Dugdale method. Line 1 is drawn formo the center of the femoral head to the 62.5% of the tibial width. Line 2 is drawn from the center of the talus to the 62.5%. The angle formed by line 1 and 2 is the correcting angle.

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  Figure 3 Weight-bearing scanography measure method: a template was cut through the osteotomy site and the tibia was rotated until the weight bearing line (WBL) through the 62.5% coordinate.

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  Figure 4 Pes anserinus was detached from the attachment and then pulled inward. The metaphyseal flare could be identified. MCL, medial collateral ligament.

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  Figure 5 Anteroposterior fluoroscopy view of the knee showing the safe zone. A, tip of the fibular head; B, circumference line of the fibular head.

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  Figure 6 An osteotomy should be performed until only 5 to 10 mm of the lateral cortex is left.

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  Figure 7 Space can be maintained by inserting the metal block into the osteotomy surface.

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  Figure 8 (A) Second osteotomy was performed with a 100°–110° tilt to the first osteotomy site. (B) The 3 or 4 chisel technique is used to open the site of osteotomy.

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  Figure 9 During uniplanar osteotomy, a metal block is fixed to the plate using screw.

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  Figure 10 After screw fixation of the proximal part, hyperextension and internal rotation of knee, fix the distal part.

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