Complications with OW HTO: 3 Common Mistakes & How I Avoid Them Anil Ranawat, MD Hospital for Special Surgery New York, NY
HSS educational activities are carried out in a manner that serves the educational component of our Mission. As faculty we are committed to providing transparency in any/all external relationships prior to giving an academic presentation. ANIL RANAWAT, MD Disclosure: I DO have a financial relationship with Smith and Nephew, Stryker Mako, Conformis, Elesevier and Arthrex
Renaissance HTO is experiencing a rebirth akin to the cultural movement beginning in Italy in the late Middle Age encompassing a revival of classical principles and modern ideas - Philipp Lobenhoffer, Chairman Knee Expert AO Group
Why I Love OW Osteotomy Preserves cruciates • Concomitant – collateral or • cartilage procedures Aid ACL and PCL def. • No activity restriction • Can delay need for • arthroplasty Arthroplasty is Not always • best option!
What is bad about Osteotomy Limited Indications Under/Over correction Intra-articular Fractures Patella Baja/anterior knee pain Nonunion, fixation failure Immobilization Conversion to TKA 5 Complications with HTO: 3 Common Mistakes & How I Avoid Them
Outline: 3 Common Mistakes 1. Indications / Pre-operating Planning 2. Surgical Technique – Correction/Slope – Nonunion/Delayed Union 3. Post-operative Care 6 Complications with HTO: 3 Common Mistakes & How I Avoid Them
1. Indications / Pre-operative Planning Biggest mistake : amount and location of VARUS Assess amount of varus >10º not all on tibia Location of varus > 20% of varus on femur Ideal Patient for isolated OW <87º of MPT Angle (CORA) and under <10º deformity 7 Complications with HTO: 3 Common Mistakes & How I Avoid Them
Too much deformity (>10º not all on tibia) Goal of all Osteotomy = Joint line should be parallel to the floor 8 Complications with HTO: 3 Common Mistakes & How I Avoid Them
Ideal deformity (<10º - all on tibia) Goal of all Osteotomy = Joint line should be parallel to the floor 9 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. Surgical technique Biggest mistake #1 : BAD exposure AND coronal and sagittal correction is based on wedge height in 3 planes Slope neutral 1:2 ratio (ant-post) Slope reducing 1:3 ratio If wedge gap opens too quick – check for fracture into joint or lateral hinge 10 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. Correct Exposure 11 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. Graduated Osteotomes 12 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. Understand your gap 13 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. If Pin placement is off? Too Flat and Distal Too Oblique and Proximal Lateral hinge violation Intra-articular Fracture No subluxation, but Minimal step-off, ORIF, increased BMI then recut or accept 14 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. Surgical technique Biggest mistake #2 : delayed / nonunion Use rigid fixation AO technique Over – correct, then compress = tension band technique Use allograft/BMAC Progressive Weight-bearing 15 Complications with HTO: 3 Common Mistakes & How I Avoid Them
2. Over-correct, then Compression plating Goal of all OW Osteotomy = COMPRESSION AT OSTEOTOMY SITE 16 Complications with HTO: 3 Common Mistakes & How I Avoid Them
3. Post-operative Care Biggest mistake : inappropriate WB and PT Early WBAT has shown increased bone healing CPM all patients minimize baja = better func. Medication: Ca/Vit D for all, ? Bone stimulator, DVT prophylaxis 17 Complications with HTO: 3 Common Mistakes & How I Avoid Them
4. Conclusion 3 common mistakes with OW HTO 1. Inadequate templating Look for CORA 2. Improper Surgical technique Understand EXPSOURE, gap height, pin placement and compression technique 3. Bad Post-operative Protocol <Aggressive WB, CPM and meds 18 Complications with HTO: 3 Common Mistakes & How I Avoid Them
Why I love OW HTO? • Biomechanically sound • Maintains high function • Versatile / Durable • Bone Preserving • Reproducible technique with less complications with improved fixation Should be a tool in armentarium of all knee surgeons!
Thank You!
Recommend
More recommend
