With correct indications, OWHTO is a reliable procedure for medial knee arthritis/overload. The outcomes reported are similar to those from other studies, although the variables related to outcomes are slightly different.

Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10 % of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.

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Statistical and clinical analysis showed that HHS is highly valid and reliable in this new Italian version.

Abstractopening wedge high tibial osteotomy (oWHto) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for oWHto are medial compartment osteoarthritis and varus malalignment of the knee; recently oWHto has been used successfully in the treatment of double and triple varus. oWHto, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. the aim of this study is to review the literature on oWHto, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at midterm follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty).Keywords: high tibial osteotomy, knee, osteoarthritis, opening wedge, prognostic factors. IntroductionHigh tibial osteotomy (Hto) is a widely accepted procedure for treating varus alignment of the knee associated with medial compartment overload/osteoarthritis (oA). the purpose of the procedure, which may be a medial opening wedge, lateral closing wedge, dome or "en chevron" osteotomy, is to shift the mechanical axis of the lower limb from the medial to the lateral compartment, thereby reducing the load and contact area over the medial compartment. the first references to Hto date back to 1961 (1); for a long time, closing wedge high tibial osteotomy (CWHto) was the gold standard of treatment in this field. Consequently, there exist numerous studies dealing with aspects (survival and complications) of CWHto. CWHto involves fibular osteotomy, common peroneal nerve dissection, proximal tibiofibular joint disruption, and bone stock loss (2, 3). Furthermore, with this procedure it is difficult to obtain gradual correction of the axis. For these reasons, opening wedge high tibial osteotomy (oWHto) has been gaining popularity in recent years. Moreover, oWHto allows for better tuning of the osteotomy as well as triplanar and gradual correction. the literature of recent years therefore contains various papers on different aspects of oWHto: indications, surgical technique, limits and results. the aim of this study is to review the literature on oWHto, considering indications and prognostic factors, outcomes and limits of the procedure. IndicationsCorrect patient selection is mandatory for achieving good results with oWHto (4, 5). According to the literature, the factors that could influence the prognosis are: age, body mass index (BMi), grade of oA, range of motion (RoM), and associated instability. in order to gain a better understanding of the correct indications for oWHto, we have reviewed each of these factors as examined in the most recent literature.