Open Wedge High Tibial Osteotomy Principles and Techniques

BY MICHAEL SCHÜTZ, KENICHI GOSHIMA, TAKESSHI SAWAGUCHI, AND YE HUANG

Blog OPpen Wedge

Learning Objectives

To develop a general image of current practices and principles relevant to knee-preserving surgery, normally in younger, active patients.
To understand the most common indicators for knee-related osteotomies.
To understand the x-ray views that are most useful for measuring osteotomy-relevant joint angles.
To understand how to prepare for an open wedge high tibial osteotomy, including measuring the relevant angles, determining the site or sites that require correction, and determining the locations and sizes of corrective openings.

Summary:

While total or unicompartmental knee arthroscopies (TKA and UKA) are commonly recommended for elderly patients, osteotomy is often indicated as a long-term solution for younger, more active patients. After a brief introduction by Michael Schütz, the AO webinar on this topic includes three presentations:

Kenichi Goshima: Indications for osteotomies around the knee
Takeshi Sawaguchi on leg axes, joint angles and anatomy. This includes a video of actual surgery, showing how to do the open wedge high tibial osteotomy with a TomoFix Osteotomy System.
Ye Huang: Planning of HTO / How decide on the location(s) and extent of correction.
Takeshi Sawaguchi presents a video of an entire open wedge high tibial osteotomy, including commentary on useful techniques and tips on how to avoid common pitfalls.

Summary:

While total or unicompartmental knee arthroscopies (TKA and UKA) are commonly recommended for elderly patients, osteotomy is often indicated as a long-term solution for younger, more active patients. After a brief introduction by Michael Schütz, the AO webinar on this topic includes three presentations:

Kenichi Goshima: Indications for osteotomies around the knee
Takeshi Sawaguchi on leg axes, joint angles and anatomy. This includes a video of actual surgery, showing how to do the open wedge high tibial osteotomy with a TomoFix Osteotomy System.
Ye Huang: Planning of HTO / How decide on the location(s) and extent of correction.
Takeshi Sawaguchi presents a video of an entire open wedge high tibial osteotomy, including commentary on useful techniques and tips on how to avoid common pitfalls.

Watch a video recording of the original AO webinar:

About the authors

Michael Schuetz

Moderator Michael Schütz is a practicing orthopedic trauma surgeon in Brisbane. He also serves as Professor and Chair/Director of Jamieson Trauma Institute at the Queensland University of Technology’s School of Clinical Sciences.

Takeshi Sawaguchi

Takeshi Sawaguchi (Japan) is Clinical Professor of Orthopaedic Surgery at the Kanazawa University School of Medicine. He is Vice President of Toyama Municipal Hospital, where he is also Director of the Department of Orthopaedic Surgery & Joint Reconstructive Surgery and an expert in high tibial osteotomy. He also serves as the current President of AOTrauma Japan.

Kenichi Goshima

Kenichi Goshima is a practicing orthopedic surgeon and an expert in high tibial osteotomy in the Department of Orthopedic Surgery and Joint Reconstructive Surgery, Kanazawa Munehiro Hospital, Kanazawa, Japan and an orthopedic surgeon in the Toyama Municipal Hospital’s Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama, Japan.

Ye Huang is a practicing orthopedic surgeon and an expert in high tibial osteotomy at Beijing Jishuitan (JST) Hospital, Beijing, China.

Recommended reading:

Schröter et al., Lower Limb Deformity Analyses and the Planning of an Osteotomy, J Knee Surg 2017;30:393–408
(J Knee Surg 2017 Jun;30(5):393-408. doi: 10.1055/s-0037-1603503. Epub 2017 Jun 9.)

Paley, Dror, Principles of Deformity Correction, Springer Berlin, Heidelberg, Softcover ISBN: 978-3-642-63953-1Published: 04 December 2014; eBook ISBN: 978-3-642-59373-4 Published: 10 January 2014

Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 2013;21:170-180.

Schuster P, Geßlein M, Schlumberger M, et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 2018;46:1362-1370.

Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Nakanishi A, Inoue D, Shima Y. Large opening gaps, unstable hinge fractures, and osteotomy line below the safe zone cause delayed bone healing after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2019;27:1291–1298.