High Tibial Osteotomy: Role in Knee Arthritis

High Tibial Osteotomy: Role in Knee Arthritis

HTO is viewed as a feasible alternative in cases of isolated medial compartment Knee Osteoarthritis (OA) as a way to maintain function, relieve pain when the articular cartilage is not completely worn and in-addition, can be effective in delaying the need for Total Knee Arthritis

Indications and Patient selection

The main indication for HTO is the correction of varus alignment in medial unicompartmental OA of the knee. The aim of the procedure is to reduce load on the medial compartment by correcting or slightly overcorrecting alignment of the knee into the valgus.

Selecting the ideal patient is crucial in achieving good results with HTO for medial knee OA. The list of characteristics for the ideal HTO patient is as follows:

• Isolated medial joint line pain with normal lateral and patellofemoral compartments
• Absence of Inflammatory arthritis
• Age 40 to 60 years
• Body mass index (BMI) < 30
• High-demand activity but no running or jumping
• Varus malalignment < 15 degrees
• Full range of movement
• Normal ligament balance
• Non-smoker and some level of pain tolerance

Procedure:

A high tibial osteotomy refers to the division of the upper end of the shinbone just below the knee. The gap thus created is opened up and stabilized, allowing realignment of the limb. The overall aim of the procedure is to biomechanically unload a diseased compartment of the knee joint and more appropriately and equitably distribute the weight bearing forces onto the better-preserved compartment of the knee joint.

Advantages

The advantage of a tibial osteotomy over a total knee replacement is that patient has retained his / her own knee. This is especially important in young patients as this allows them to delay the total knee surgery and at the same time maintain their active life style.

Disadvantages and Potential complications

Patient is advised not to bear weight on operated leg for 6 weeks following surgery and may require immobilization with brace or cast. Potential risks include infection (<1%), Delayed union or Non-union of the osteotomy, fracture extension into the joint, injury to nerves or blood vessels, DVT and anaesthesia risks etc.

Conclusion:

High tibial osteotomy is a useful tool in relieving pain, disability and delaying the total knee replacement surgery in younger patients with active life style and limited disease. For best results, good surgical technique and strict adherence to patient selection criteria is of utmost importance.