Improvements in surgical technique of valgus high tibial osteotomy

Abstract

We present four technical modifications of high tibial osteotomy which improve its safety and reproducibility. (a) Open wedge correction: opening wedge osteotomy from the medial side avoids lateral muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy, and leg shortening; only one osteotomy needs to be performed and the correction can be adapted intraoperatively. (b) Biplanar osteotomy: in addition to the transverse osteotomy of the posterior tibia a second ascending osteotomy in the coronary plane underneath the tibial tuberosity is performed. This provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting of the osteotomy planes. (c) Incomplete osteotomy with plastic deformation of the tibia: 10 mm of lateral bone stock is left intact. The osteotomy is opened gradually over several minutes by sequential impaction of flat chisels or by use of a special spreading tool. Manifest fractures of the lateral cortex with resulting instability are avoided. Rapid bone healing is promoted. (d) Rigid fixation: stable osteosynthesis allows for early mobilization and avoids losses-of-correction. We use a medial plate-fixator which can be applied percutanously. In 112 patients operated on using this modified technique no pseudarthosis or loss-of-correction was observed.

Opening wedge tibial osteotomy for large varus deformity with CeraverTM resorbable beta tricalcium phosphate wedges

“…Although it is currently believed that tibial osteotomy is unlikely to give a satisfactory results in patients who have severe preoperative varus deformity [1,4,16,17], in our series this was not found to be true. Most of the knees had a good result at the ten year follow-up examination.…”

Fixator-assisted Technique Enables Less Invasive Plate Osteosynthesis in Medial Opening-wedge High Tibial Osteotomy: A Novel Technique

“…Since angle-stable locking plates were introduced, implant-related complications have been reduced considerably [2,12]. However, soft tissue problems, delayed union or nonunion, and deep infection still are reported to be relatively frequent [9,12,15,23,25] in conventional opening-wedge high tibial osteotomy, which may result from extensive soft tissue exposure to protect posterior neurovascular structures or to apply the plate while maintaining a distractor in place during the surgery.…”

Open wedge re-correction high tibial osteotomy in an elderly patient with a varus angulated non-united dome-shaped high tibial osteotomy

“…Meanwhile, the open wedge HTO with the TomoFix™ plate, which was introduced by Staubli et al (2003), has become a widespread surgical technique (Lobenhoffer and Agneskirchner, 2003;Niemeyer et al, 2008;2010;Takeuchi et al, 2008;2009;Schröter et al, 2012;Floerkemeier et al, 2013). Only some publications of revision surgery after failed osteotomies are available today (Tsuda et al, 2004;Teitge and van Heerwarden, 2008;Watanabe et al, 2008).…”

“…Risks of loss of blood and infection during such a surgery would be The biplanar open wedge HTO is a surgical technique that has been developed to avoid complications like peroneal nerve palsy (Lobenhoffer and Agneskirchner, 2003;Staubli et al, 2003). Even special implants have been developed (Lobenhoffer and Agneskirchner, 2003;Lobenhoffer et al, 2004;Stoffel et al, 2004;Prix, 2005;Asik et al, 2006;Orsel et al, 2006). The biplanar osteotomy is based on an L-shaped cut at the tibial head in the horizontal and vertical directions.…”

“…The biplanar osteotomy is based on an L-shaped cut at the tibial head in the horizontal and vertical directions. By using the TomoFix™ plate, a fixation without cancellous bone transplantation has become possible (Lobenhoffer and Agneskirchner, 2003;Staubli et al, 2003). Biomechanical investigations in sawbone models showed a high primary stability with a limit of 1 606 N in axial load (Agneskirchner et al, 2006).…”