Clinical Research Directory

Hybrid Closed Wedge High Tibial Osteotomy

Osteoarthritis (OA) is the most prevalent condition of the knee joint. High tibial osteotomy (HTO) is an effective treatment for medial compartmental osteoarthritis (OA) of the knee with good clinical outcomes. In particular, the two most commonly used surgical techniques of HTO are medial open wedge HTO (OWHTO) and lateral closed wedge HTO (CWHTO). However, OWHTO has been reported to have a negative effect on the patellofemoral (PF) joint postoperatively due to a decrease in patellar height and an increase in PF contact pressure, in contrast to CWHTO. Biomechanical studies indicated that the alteration in patellar height can be attributed to distalization of the tibial tuberosity following OWHTO, which leads to the patella being pulled down toward the joint lines. In CWHTO, the tibial tuberosity was reported to move proximally in a biomechanical study. Therefore, CWHTO may lead to improvement of PF joint congruity compared with descending OWHTO. Meanwhile, CWHTO has also been reported to have several disadvantages, such as loss of the large bone block below the lateral tibial plateau, increase in lateral offset due to the horizontal osteotomy, and late full weight-bearing walking. To improve these disadvantages, the hybrid closed wedge HTO (HCWHTO) technique, a kind of CWHTO, was developed. The points of difference for HCWHTO compared with conventional CWHTO are an oblique osteotomy to achieve a large contact area, a contact for the lateral cortices in the proximal and distal fragments without lateral offset for early full weight-bearing, and a removal of a smaller bone wedge to maintain leg length. Furthermore, this procedure has good effects on PF joint congruity through improvement in tibial tuberosity-trochlear groove distance and the proximalization of the tibial tuberosity when compared with OWHTO If a patient has PF-OA preoperatively, HCWHTO may be chosen to prevent progression of PF-OA postoperatively. However, HCWHTO may be performed in patients with varus deformity of the knee combined with PF-OA, because progression of PF-OA is correlated with varus knee .