Technique and Outcomes of Opening Wedge High Tibial Osteotomy

High tibial osteotomy (HTO) is a surgical procedure that involves cutting the proximal tibia in an attempt to change the weight bearing axis from the medial to the lateral compartment of the knee. It is particularly suited to young and middle age active patients, who have a primary degenerative arthrosis involving the medial compartment in a malaligned limb causing pain and functional limitation. HTO has been often presented as a possible alternative to prosthetic joint replacement. However the indications depend on the stage of the degenerative cartilage changes and on the patient’s profile and typically differ from the indications for uni or total knee replacement. Over the last 10 years the indication for a HTO have expanded to include patients with cartilage damage that can be treated with one of the new cartilage repair techniques and patients with chronic ligament deficiency associated with varus malalignment. The opening wedge HTO is a relatively new technique and it will be illustrated here in a step by step approach. This technique differs from Coventry’s lateral closing wedge osteotomy by obtaining the correction of the varus deformity by adding a wedge medially. It is based on a special dedicated system of instruments and plates (Arthrex, Naples, FL).