High tibial osteotomy is an orthopedic knee realignment surgery that includes the alignment of the knee joint. The intention of this procedure is pain reduction, functional improvement of the knee, and the reduction of disability in that particular knee by shifting its weight-bearing part away from the area where damage to the cartilage occurs. This article will provide information in detail about this surgical operation. We hope this will give any person who is presented with the decision whether or not to have an HTO procedure enough information on which to base a decision.
What is high tibial osteotomy operation? This operation anatomically realigns the knee. The primary indications for an HTO include alleviating unicompartmental pain due to osteoarthritis, restoration of functional knee realignment surgery, correction of malalignment with a concomitant ligamentous insufficiency, and/or treatment of a bony deformity that may preclude ligamentous reconstruction. There are obvious differences between HTOs for possible multicompartmental disease, HTOs combined with either cartilage repair or osteochondral transfer procedures, and HTO in the varus knee. The terminology and surgical techniques have changed over time, and it is easily confusing for any patient considering an HTO. Patient education is indeed the key to any successful surgical intervention.
Indications of high tibial osteotomy include young patients with acute knee arthritis and varus deformity. Varus deformity is a condition of the knee where it takes on a deformity that is usually bent inward, bowing the legs and thus increasing pressure upon the medial compartment of the knee. Indication for the performance of HTO is in cases of early or moderate knee arthritis with still-intact cartilage, consisting of 4 to 6 on the Kellgren-Lawrence scale with modification. Patients with such characteristics, when there is varus deformity, are encouraged to undergo HTO in order to gain a new alignment.
High tibial osteotomy guide: A person who receives HTO will get several benefits, including-
Key steps prior to knee realignment surgery are general assessments, informed patient consent, and choosing the most appropriate imaging modalities. Although long-leg radiography was the standard image in nearly all studies and the only available image in the initial projects, CT was reformulated for planning in HTO at a later date to detect individual antecurvation of the tibia. Furthermore, MRI and cone-beam CT images have been indicated, especially when investigating meniscus injuries and improving patient care by analyzing the weight-bearing line or mechanical axis.
Determination of correction based on the high tibial osteotomy guide gives rise to the decision about the surgical procedure, including the different tibial procedures in terms of the osteotomy as well as the direction of the correction. There are different osteotomy techniques available, such as medial-positive osteotomy or oblique osteotomy. With respect to the different angles, the medial-positive osteotomy and valgising the knee can be performed with different techniques.
OWHTO and LCWHTO are the most common osteotomy techniques for extravertebral HTO, but there is no clear evidence showing which method is preferable in elevation with regard to the purpose of the deformity and type of correction. The techniques were performed percutaneously with a drill from the medial or lateral entry point after the osteotomy gap distractor was used. Most often, an OWHTO is stated as a “high osteotomy” and an LCWHTO as a “low osteotomy.” The exposure of distal fixation can be attended by one long skin incision that shares the wrist of the leg and tibia tracking. Most orthopedic surgeons will utilize a tourniquet. OWHTO is the most performed osteotomy in Europe and also in the USA. The flexibility of the technique is due to the variability of its performance. As Hohe Tibiaosteotomie erklärt, the operation shall comprise patient evaluation, surgical technique, postoperative management, outcomes, regeneration processes, and finally, the case. The patients in all studies underwent complete clinical assessment, including physical examination and radiographic assessment as a minimum.
Erholung nach Hohe Tibiaosteotomie erklärt: Es ist oft ein langsamer und manchmal frustrierender Prozess. Viele Patienten können sechs Wochen lang ihr Gewicht nicht oder nur eingeschränkt tragen. Danach wird das operierte Bein langsam wieder voll belastet. Zu Beginn der Rehabilitation stehen Schmerzkontrolle, Schwellungskontrolle, Einschränkungen bei der Beinpositionierung und der Schutz der Operation im Mittelpunkt, die eher als Pseudarthrose identifiziert wird. Zwischen der sechsten und zwölften Woche werden die meisten Patienten untersucht und erhalten grünes Licht für den Beginn ihrer Rehabilitation und ihrer Aktivitäten unter physiotherapeutischer Aufsicht. Viele orthopädische Chirurgen verwenden ein auf ihre Patienten zugeschnittenes Rehabilitationsprotokoll. Da immer mehr orthopädische Chirurgen rekonstruktive Eingriffe durchführen, wird die Verwendung von Rehabilitationsprotokollen zunehmend standardisiert. Bislang gibt es keine randomisierten kontrollierten Studien zu verschiedenen Rehabilitationsprogrammen und der optimalen Rehabilitation nach einer Osteotomie.
Patienten mit hohen Tibiaosteotomien erhalten ihre Rehabilitationsprogramme von ihrem Chirurgen. Es wird angenommen, dass das Rehabilitationsprogramm aufgrund der verschiedenen Operationstechniken für hohe Tibiaosteotomien individuell angepasst werden sollte. Der Rückgriff auf Programme wie Heimprotokolle ohne Physiotherapie kann die erfolgreiche Genesung des Patienten mit einer hohen Heilungsrate fördern. Schmerzen können den Genesungsprozess erschweren. Sie können mit verschreibungspflichtigen oder rezeptfreien Schmerzmitteln behandelt werden. Es gibt auch viele Programme mit Physiotherapie für angeleitete Bewegungsübungen und Kräftigungsübungen, die ebenfalls erfolgreich waren. Es ist wichtig, Patienten nach einem geschlossenen Keil oder einer Kuppeloperation nicht zu vergessen. Obwohl diese Patienten Gewicht tragen, leiden sie in der Regel monatelang unter erheblichen Knochenschmerzen, während die Knochen zusammenwachsen. Es ist wichtig, dass Chirurgen und Patienten Ziele und Meilensteine für den Genesungsprozess festlegen. Während dieser Zeit können Komplikationen auftreten, die den Rehabilitationsverlauf beeinträchtigen können. Nach dem öffnenden Keil wurden im Vergleich zu den herkömmlichen schließenden Verfahren deutlich weniger Komplikationen berichtet. Schwellungen oder Ergüsse im Gelenk gehen in der Regel zurück. Auch Physiotherapie und Krafttraining haben Erfolge gezeigt. Daher ist es wichtig, nach 12 Wochen Rehabilitationsziele festzulegen, die für die Rückkehr zu normalen Aktivitäten erreicht werden müssen. In dieser entscheidenden Phase ist die Korrektur der Deformität wichtig.
The performance of a knee realignment surgery has been refined over the years, and surgeons are well aware of the potential risk profile. There are many potential complications associated with a high tibial osteotomy, especially at the standard medial opening site. The most common factors potentially contributing to the complications are patient-specific factors and the quality of the osteotomy displacement, fixation tools, and preoperative planning. The biggest risk occurs when the surgeon stops evaluating the patient after one year without a clinically successful outcome evaluation. Most of the complications could have been found in a few months postoperatively if only more aggressive routine postoperative examinations were performed. The administration of informed consent and a detailed schedule for consequences is essential to clinically successful outcomes.
Complications of the knee realignment surgery include malunion, nonunion, lateral cortical fracture, peroneal nerve palsy, intra-articular complications, and joint penetration with hardware. To avoid complications, removal of hardware must be performed to improve soft tissue balancing and to perform total knee arthroplasty in the following situations: no painful hardware status and no contraindications. Proper patient case selection, a meticulous osteotomy technique, and bone healing enhancement reduce the probability of complications. The most challenging situation, nonunion with knee pain evolution, requires immediate precise examination of the patient’s comorbidities, alcohol and nicotine intake, and technique blunders before planning revision. Careful examination of possible complications is critical to understanding why the patient has not succeeded.
Unser Ziel ist es, die Lebensqualität der Patienten zu verbessern, indem wir den Prozess der Gliedmaßenverlängerung und Stiefelverlängerung auf gesunde und sichere Weise durchführen.
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