High Tibial Osteotomy
What is High Tibial Osteotomy?
High Tibial Osteotomy is a surgical procedure that cuts and reshapes the upper part of the tibia (shinbone) to realign the knee joint. Typically performed to address unicompartmental osteoarthritis affecting the inner (medial) part of the knee, this procedure helps redistribute the weight-bearing load. By shifting the load away from the damaged area to a healthier part of the knee, HTO not only alleviates pain but also slows the progression of arthritis, improving joint function over time.
Indications for High Tibial Osteotomy
High Tibial Osteotomy is ideal for patients who meet the following criteria:
- Unicompartmental Osteoarthritis: Particularly helpful for those with osteoarthritis in the medial knee compartment.
- Younger, Active Patients: Recommended for younger individuals who may not be suited for total knee replacement due to their activity levels.
- Knee Malalignment: Effective for those with varus deformity (bow-leggedness) or similar alignment issues.
- Activity-Related Pain: Beneficial for those whose knee pain worsens with activity but improves with rest.
- Healthy Joint Function: Best for patients with intact ligaments and a good range of motion in the knee.
Types of High Tibial Osteotomy
- Closing Wedge Osteotomy: A wedge of bone is removed from the lateral side of the tibia, and the bone is closed together to realign the knee.
- Opening Wedge Osteotomy: A wedge-shaped gap is created on the medial side of the tibia, which is then filled with a bone graft or a synthetic bone substitute to realign the knee.
Postoperative Care and Rehabilitation
Postoperative care is crucial for the success of HTO. It includes:
- Pain management with medications.
- Use of crutches or a walker to avoid putting weight on the operated leg for several weeks.
- Physical therapy to restore range of motion, strengthen the muscles, and gradually return to normal activities.
- Regular follow-up appointments to monitor healing and ensure proper alignment.
Benefits of High Tibial Osteotomy
- Joint Preservation: High Tibial Osteotomy helps preserve the natural knee joint, delaying or potentially avoiding the need for total knee replacement.
- Pain Relief: By redistributing the load, HTO reduces pain in the affected compartment, providing significant relief.
- Improved Function: With better alignment, patients experience improved knee function, allowing them to engage in physical activities with greater ease.
- Slowing Disease Progression: By easing stress on the damaged area, HTO helps slow osteoarthritis progression, promoting long-term joint health.
High Tibial Osteotomy Complications
- Infection: Risk of wound or deep tissue infection.
- Blood Clots: Potential for deep vein thrombosis.
- Nonunion/Delayed Healing: Bone may not heal as expected.
- Overcorrection/Undercorrection: Alignment issues post-surgery.
- Nerve/Vessel Injury: Rare but possible during surgery.
- Stiffness: Reduced knee range of motion.
Conclusion
High Tibial Osteotomy offers an effective solution for patients with knee osteoarthritis and malalignment. By correcting alignment, it preserves the joint, reduces pain, and improves function. To ensure optimal results, careful patient selection, precise surgical technique, and thorough postoperative care are vital.