June 20, 2024

High Tibial Osteotomy is the mini-invasive surgical approach for the management of osteoarthritis of the knee. This osteotomy is further classified into the following types:

  1. Medial open wedge osteotomy
  2. Lateral close wedge osteotomy
  3. V osteotomy
  4. Dome osteotomy
  5. Biplanar osteotomy

All required either fibular osteotomy or release of proximal tibiofibular joint for tibial osteotomy

High Tibial Osteotomy
High Tibial Osteotomy

Main indications of HTO

Correction of varus malalignment in the medial compartment of the knee

Ideal candidates for HTO

The followings are the high candidates for high tibial osteotomies

  1. Age 40-60 yr
  2. BMI < 30
  3. Isolated medial joint line pain
  4. High demand
  5. Malalignment <15%
  6. Full range of motion
  7. Nonsmoker
  8. Normal ligamentous balance
  9. Some level of pain tolerence

Lateral close wedge osteotomy

Osteotomy is done in the proximal lateral part of the tibia with closing type to achieve 1° correction 1 mm of bone should be excised

Fixation methods by:

  • Cylindrical cast
  • External Fixator
  • Staple fixation
  • Plate fixation
  • Fixed angle implants

Complications of Lateral Close wedge osteotomy

  1. Recurrence of varus
  2. Over/under correction
  3. Altered patella-femoral kinematics
  4. Fractures
  5. Change in tibial inclination and increase in joint line obliquity
  6. Delayed/non- union
  7. Peroneal nerve and popliteal artery injury
  8. Shortening of leg
  9. Compartment syndrome, infection, Thromboembolisms

Medial open wedge osteotomy advantages over closed wedge osteotomy

  1. Allows precise correction of the angular deformities and the amount of correction can easily be changed intraoperatively
  2. Slope changes are minimal and can be precisely controlled
  3. Doesn’t lead to the tibial plateau and diaphyseal offset disturbances
  4. No need to disturb the proximal tibial fibular joint
  5. Only one saw cut is needed
  6. No leg shortening

Osteotomy is performed proximal to the tibial tubercle

The gap created may be filled with bone graft/bone graft substitute

Complications of Medial Open wedge osteotomy

  1. Delayed healing + High nonunion rates
  2. Prolonged non-weight bearing
  3. Leg lengthening
  4. Loss of correction
  5. Tibial slope changes

Radiographic evaluations in Osteoarthritis Knee

A neutral mechanical axis is defined as a line from the hip through the knee center through the ankle center.

Axis of Knee

Valgus cut angle = AAF-MAF (5-7°)

The distal femoral cut is perpendicular to MAF

The anatomical axis of tibia (AAT)= Mechanical axis of tibia (MAT)

In case of tibial deformity

Tibial cut angle= AAT-MAT

Axis of tibia
Axis of tibia

Other Surgical Options for OA Knee


To relieve mechanical symptoms

  • Palliative treatment
  • Meniscus tears and catching /locking
  • Loose bodies
  • Unstable cartilaginous flap

Unicompartmental arthroplasty

Patello-femoral replacement procedure

Isolated patella-femoral arthritis

Total Knee Arthroplasty