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27, 1st avenue, Besant nagar
Chennai 600090, India
Mobile: 00 91 92821 65002
Tel: 00 91 44 24912905,
 
Hospital
Chettinad Health City Rajiv Gandhi Salai, Kelambakkam, Kanchipuram Dist,
Tamil Nadu 603 103, India
T.+91(0)44 27475225,27475959
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High tibial osteotomy
Indications- Bow legs casuing inner half knee pain
Secondary osteoarthritis develops in knee joints in which a process of accelerated chondropaenia occurs. Knees with varus or valgus malalignment are prone to develop secondary osteoarthritis. Varus malalignment is corrected by a high tibial osteotomy. The osteotomy is done above the tibial tubercle. It can be a closed wedge from the lateral side or an open wedge from the medial side. The open wedge removes the slack of the medial collateral ligament and removes the lateral swaying gait. The open wedge can be created by interposing a bone substitute or by hemicallotasis. In hemicallotasis, bony regeneration occurs in the osteotomy site medially as it is being distracted. Pain relief occurs due to a combination of factors for a period of up to 10 years. The pre-requisites for this operation is that the patient must not be obese, have a good range of motion, the ligaments should be intact and there should be no lateral subluxation of the tibia. It is not indicated for rheumatoid arthritis. The chief advantage of the procedure is that no prosthesis is used. Osteotomies are not difficult to convert to a knee replacement if the need arises in future.It is a good operation for relatively active people.
Patient selection
It is an elective orthopaedic surgery procedure which does not involve any total knee implant. Men are more likely to need and appreciate a high tibial osteotomy as a surgery for their knee pain than women as this will allow them to carry on their work permitting flexion.
Alternative to knee replacement
This is an alternate procedure to TKR in the younger patient. It postpones the need for a knee replacment by at least 10 years
Types
Opening wedge osteotomy In this procedure I jack open the inner half of the top of the tibia and put in a plate and bone graft to straighten the tibia. In the closing wedge, a wedge of bone is removed from the outer half of the top of the tibia and the osteotomy is fixed with an internal fixation.
Post op
The patient will have to remain non weight bearing for a short period of 3 months till the osteotomy has healed.