High Tibial Osteotomy for Varus Deformity of the Knee

Ryan Murray, Philipp W Winkler, Humza S Shaikh, Volker Musahl, Ryan Murray, Philipp W Winkler, Humza S Shaikh, Volker Musahl

Abstract

High tibial osteotomy is a powerful technique to treat symptomatic varus deformity of the knee and is successful when properly indicated and performed. Indications include varus deformity with medial compartment osteoarthritis, cartilage or meniscus pathology. Several techniques exist to correct symptomatic varus malalignment along with concomitant procedures to restore cartilage or meniscus injuries. Evidence supporting high tibial osteotomy for symptomatic medial compartment pathology exists, which provides a durable solution for joint preservation. This review will discuss the indications, techniques, and outcomes for high tibial osteotomies used in the treatment of symptomatic varus deformity of the knee.

Conflict of interest statement

Dr. Musahl or an immediate family member has received research and education support from Smith & Nephew and Arthrex as well as publishing royalties from Springer; he is also a paid consultant for Smith & Nephew. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Murray, Dr. Winkler, and Dr. Shaikh.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.

Figures

Figure 1
Figure 1
Standing long leg AP radiograph demonstrating the mechanical (yellow) and anatomic (red) axes of the femur and tibia of the left lower extremity. The anatomic mechanical femoral angle is 5°. The mechanical axis of the left lower extremity is marked with a blue line. The anatomic axis of the femur and tibia of the left leg is marked with a white line and forms a 177° anatomic femorotibial angle.
Figure 2
Figure 2
Standing long leg AP radiograph demonstrating varus alignment of the right lower extremity. The femorotibial angle is 8° varus (yellow). The mechanical axis of the right lower extremity (white) is 15 mm medial to the center of the knee joint.
Figure 3
Figure 3
Full-length standing lower extremity radiograph demonstrating the anatomic medial proximal tibial angle of 86° and anatomic lateral distal femoral angle of 85° of the left lower extremity. Femoral and tibial joint lines are demonstrated on the right lower extremity.
Figure 4
Figure 4
Medial opening wedge high tibial osteotomy. A, Preoperative radiographs of a 45-year-old individual with symptomatic medial compartment OA. B, Lamina spreaders are used to gently distract the osteotomy once complete. C, Two-year follow-up PA flexion weight-bearing radiographs showing preserved medial compartment joint space with mild OA progression. OA = osteoarthritis

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Source: PubMed

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