Chapter 62 combined anterior cruciate ligament reconstruction and high tibial osteotomy davide edoardo bonasia and annunziato amendola chapter synopsis this chapter describes the indications, planning, and surgical technique for combined anterior cruciate ligament acl reconstruction and high tibial osteotomy hto. High tibial osteotomy hto is a widely accepted operation for medial tibiofemoral osteoarthritis and varus deformity of the lower extremity. This jointsparing operation is successfully used for the correction of a misaligned joint knee in arthritic patients. The goal of the surgery is to reduce, or even eliminate, the pain by unloading the medial compartment. Pdf high tibial osteotomy for the treatment of medial. Jackson is credited being the first in the englishlanguage literature to report performing aproximal high tibial osteotomy hto to treatosteoarthritis of the knee. What are the benefits of high tibial osteotomy with openwedge technique in varus oa of the knee. High tibial osteotomy surgery importance, risk and cost. However, it prolongs the life of a damaged knee, helps relieve pain in the knee and delays the need for a. Its studies show improvement in pain, function and quality of life in people who use the device.
Background a new system for performing openwedge high tibial osteotomy hto, the ibalance hto system arthrex, has been recently developed in order to make the surgery more reproducible and safe. Efficacy has been demonstrated in the short, medium and long term. Angular deformities were first described by mikuliczradecki in 1880. The instruments also allow for alignment of the osteotomy to the sagittal and coronal planes to preserve tibial slope. Opening wedge osteotomy system using peekpower hto plate 2nd generation keywords. High tibial openwedge osteotomy new techniques and early results 331 crest were inserted into the d efect hernigou et al. High tibial osteotomy is an orthopaedic surgical procedure which aims to correct a varus deformation with compartmental osteoarthritis. The titanium tibial opening wedge osteotomy plates feature a 4 hole design and are available with either a straight or sloped tooth to change or preserve the native tibial slope.
Both medial opening wedge and lateral closing wedge. But in 2015, arthrex announced a recall of the ibalance tka tibial trays, and now the company faces lawsuits. Supra malleolar tibial osteotomymedial opening wedge with. Clinical indications include varus alignment of the knee associated with medial compartment arthrosis, knee instability, medial compartment overload following meniscectomy, and. In this procedure, the surgeon makes an incision in front of the knee and removes a small wedge of bone from the upper part of the tibia or shinbone. Opening wedge osteotomy in this technique the surgeon cuts through the tibia on the medial inner side and opens a wedge, sometimes by adding a piece of bone graft from the pelvic area to hold the wedge open. The lateral closed wedge high tibial osteotomy hto described by jackson and coventry 1,2 is a classical operation to treat osteoarthritis of the medial compartment and varus deformity, but it has some problems such as peroneal nerve palsy, nonunion of fibula, and loss of the bone. High tibial osteotomy postoperative rehabilitation protocol. Our elearning platform contains high resolution images and a certified cme of the high tibial osteotomy synthes tomofix plate surgical procedure. A total of 187 patients 195 knees who underwent hto between 1990 and 2010 were retrospectively evaluated. High tibial osteotomy is a surgical procedure to realign the leg and reduce the pain you have from your knee by transferring the body weight to the preserved normal outside of the knee.
Hto produces a postoperative valgus limb alignment with shifting the loadbearing axis of the lower limb laterally. Combined anterior cruciate ligament reconstruction and. Global high tibial osteotomy market assessing major growth. This instructional surgical video shows the safe surgical technique of a medial opening wedge high tibial osteotomy hto using the tomofix system as a locked internal fixator without the need for. High tibial osteotomy hto protocol rehabilitation following high tibial osteotomy hto is an essential part of a full recovery and this process is comparatively prolonged versus alternative knee surgeries such as unicompartmental and total knee arthroplasties. Midterm outcome of openingwedge high tibial osteotomy. A high tibial osteotomy is a surgical procedure that realigns the knee joint. Open wedge high tibial osteotomy technique without bone. Orthofix us extremities xraybased pre and postoperative planning of deformity correction surgery. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. High tibial osteotomy synthes tomofix plate surgical.
Medial opening hto had been developed, because it had some advantages over the closed wedge technique. Opening wedge osteotomy system using peekpower hto. In this technical note, we present a reproducible technique for proximal tibial osteotomy. Closing wedge osteotomy is the most commonly used technique to perform a high tibial osteotomy. Surgical treatment of medial tibiofemoral osteoarthritis with opening wedge high tibial osteotomy is wellaccepted. I am on my 4th knee surgery in 4 years, this past one was a high tibial osteotomy on my left knee. The openingwedge high tibial osteotomy technique was performed as described previously by franco et al 12 using the puddu plate arthrex, naples, florida, a butterflyshaped plate that contained. High tibial osteotomy is a surgical procedure to relieve pressure on the damaged site of an arthritic knee joint. High tibial osteotomy hto is a widely accepted and performed procedure to treat medial knee arthrosis.
Arthroscopic and computerassisted high tibial osteotomy. The purpose of this study is to report and analyze the longterm outcomes of the patients who underwent high tibial osteotomy hto with three different techniques for the treatment of medial compartment arthrosis. High tibial openwedge osteotomy new techniques and early. The ibalance hto surgical technique starts with an instrument system highly specific to the ibalance implants that creates a safety envelope with lockedin retractors, allowing the surgeon to create all cuts safely and reproducibly, while significantly reducing chances of neurovascular injury and lateral hinge fractures. High tibial osteotomy an overview sciencedirect topics. Learn the supra malleolar tibial osteotomymedial opening wedge with arthrex plate surgical technique with step by step instructions on orthoracle. I have nerve damage and the surgery area of the bone bothers me which is expected.
In high tibial osteotomy, a triangular wedge of bone is cut at the upper end of the tibia and either removed or filled with bone graft depending on the patients needs. Opening wedge osteotomy system using peekpower hto plate 2nd generation author. High tibial osteotomy hto is a widely performed procedure, and good results can be achieved with appropriate patient selection and precise surgical technique. The value of osteotomy is in the knee with localised osteoarthritis, and a corresponding malalignment that is either causative of. These systems help surgeons by facilitating safe and reproducible procedures. For some patients who have knee arthritis, this surgery can delay or prevent the need for a partial or total knee replacement by preserving damaged joint tissue osteoarthritis and malalignment of the knee.
Openingwedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Our elearning platform contains high resolution images and a certified cme of the supra malleolar tibial osteotomymedial opening wedge with arthrex. High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. The simplistic design facilitates minimally invasive surgery and is optimal for lower demand patients. Opening wedge high tibial osteotomy performed without. In the treatment of lower extremity malalignment and osteoarthritis, high tibial osteotomy is a procedure that allows for the realignment of the lower extremity and thereby either shifts the weightbearing access to the healthier portion of the knee or corrects the alignment deformity. Despite which technique is used by the surgeon, treatment for symptomatic early arthritic. High tibial osteotomy postoperative rehabilitation protocol name. Each case can be very different depending on the goals of the patient, the age of the. High tibial osteotomy hto is a widely performed procedure to treat medial knee arthrosis. Learn the high tibial osteotomy synthes tomofix plate surgical technique with step by step instructions on orthoracle. Press release high tibial osteotomy hto plates market shares, insight by leading players. Arthrex osteotomy systems for the lower extremities include industry leading instrument sets, patented flush implants, a wide variety of plates and screws, along with a comprehensive portfolio of bone void fillers.
We describe our technique of arthroscopic and computerassisted. This technique has been noted to decrease patellar height5. However, maximizing procedural success and postoperative knee function still possess many difficulties. High tibial osteotomy hto is a surgical procedure performed to relieve pressure on the damaged site of an arthritic knee joint. High tibial osteotomy hto of the damaged knee joint. High tibial osteotomy hto plates market shares, insight. The procedure changes the alignment of the heel bone calcaneus. Longterm results and comparison of the three different. The role of high tibial osteotomy in the varus knee. The tomofix medial high tibial plate is suitable for both open and closedwedge osteotomies. High tibial osteotomy patient information brochures.
These plates are available in wedgeless, straight, and sloped options. Compression of the lateral hinge features and benefits higher stability four locking screws in the plate head long shaft portion evenly transmits the occurring forces into the tibial shaft. In order to stabilize this a plate is inserted once again. The ibalance hto system is an instrument set highly specific to the ibalance implants that creates a safety envelope with locked in retractors, allowing the surgeon to create all cuts safely and reproducibly, while significantly reducing chances of neurovascular injury and lateral hinge fractures.
This manipulation brings the bones together and fills the space left by the removed bone. Medial openingwedge proximal tibial osteotomy is an effective procedure for restoring proper coronal alignment and reducing knee pain. Osteotomy of the proximal tibia has been used formore than a century to correct angular deformityin the setting of rickets, poliomyelitis, andposttraumatic conditions. As stated above, this technique is used with patients with medial collateral ligament mcl instability as well. It is usually reserved for younger patients who are generally more active. For medial high tibial osteotomies tomofix medial high. This surgical technique will explain the procedure of an open and closed wedge osteotomy. Its been 7 weeks and im still in a significant amount of pain. Proximal tibial osteotomies are an important component of the surgical treatment options in the management of knee osteoarthritis. In general, published studies on hto report good longterm results with a correct patient selection and a precise surgical technique. The contourlock hto plate is a great choice for high demand patients needing a stronger locking construct for weightbearing.
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