AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-High Tibial Osteotomy, Distal Femoral Osteotomy-Catherine Hui, M.D.

High Tibial Osteotomy, Distal Femoral Osteotomy-Catherine Hui, M.D.

Pdf Summary

This presentation by Dr. Catherine Hui covers osteotomies for knee malalignment, specifically High Tibial Osteotomy (HTO) and Distal Femoral Osteotomy (DFO), used to treat conditions such as osteoarthritis and instability primarily in varus (bow-legged) and valgus (knock-kneed) knees.<br /><br />The clinical assessment includes weightbearing radiographs emphasizing the 30-degree flexion PA Rosenberg view to detect early joint space narrowing. Alignment is assessed with three-foot standing radiographs.<br /><br />HTO is indicated for varus knees with medial compartment osteoarthritis and/or instability, aiming to realign the weightbearing axis, decrease medial contact pressure, and reduce lateral tensile forces and the adduction moment. Contraindications include BMI over 35, severe flexion contracture, inflammatory arthritis, tricompartmental osteoarthritis, and lateral compartment OA.<br /><br />Two main HTO techniques for varus deformity exist: medial opening wedge (MOWHTO) and lateral closing wedge. MOWHTO has advantages such as technical ease, bone stock preservation, and predictable correction; the lateral closing wedge can be more technically challenging and reduces bone stock. Posterior tibial slope correction is critical in ACL-deficient or revision patients.<br /><br />Dr. Hui outlines a detailed postoperative rehabilitation protocol for MOWHTO emphasizing gradual progression from pain management and ROM exercises to neuromuscular training and return to sports over 6-12 months.<br /><br />For valgus deformities with lateral compartment OA, Distal Femoral Osteotomy is performed either as medial closing wedge or lateral opening wedge with similar pros and cons. The goal is restoring mechanical axis alignment through the medial tibial eminence.<br /><br />Key surgical principles include thorough preoperative planning, correcting malalignment before or during ligament reconstruction, and recognizing that realignment alone may stabilize less active patients. Long-term studies of these osteotomies show survival rates of 70-90% at 5-10 years depending on technique and patient factors.<br /><br />In summary, HTO and DFO are valuable joint-preserving surgical options addressing malalignment-related knee pathology by redistributing loads, improving symptoms, and potentially delaying the need for total knee arthroplasty.

Keywords

High Tibial Osteotomy

Distal Femoral Osteotomy

knee malalignment

varus deformity

valgus deformity

osteoarthritis

weightbearing radiographs

medial opening wedge HTO

lateral closing wedge HTO

postoperative rehabilitation