AANA Lab Course 913 - Advanced Knee Course-HTO and DFO Osteotomy Demonstration, Cory Edgar, MD

Video Transcription

Video Summary

The speaker provides a detailed surgical demonstration of distal femoral osteotomy (DFO) and high tibial osteotomy (HTO) procedures using a robust locking plate system. Key steps include initially positioning the plate before pin placement, ensuring precise alignment verified by fluoroscopy. For DFO, a closing, medial-sided wedge osteotomy is performed by removing an 8mm bone wedge guided by pins, taking care to protect neurovascular structures while cutting through the femur. The far cortex is intentionally violated to enable wedge closure and correction, which can also facilitate rotational adjustments using reference pins. Fixation is achieved by reapplying the plate and securing with screws, with compression applied to close any gaps.<br /><br />In the HTO, the procedure involves careful dissection around the MCL and pes tendons, with the osteotomy cut made perpendicular to the joint and expanded using stacking osteotomes. Posterior cortex work is critical for controlled opening. A device can be used to adjust the tibial slope if needed, popularized for revision ACL cases. Bone grafting with cancellous chips or tricortical grafts may be done for larger corrections. Postoperatively, partial weight bearing is allowed early, with patients progressing to full weight bearing by 3-4 weeks using a brace. The approach emphasizes precision, protection of soft tissues, and stable fixation for effective deformity correction.

Keywords

distal femoral osteotomy

high tibial osteotomy

locking plate system

fluoroscopy alignment

closing wedge osteotomy

tibial slope adjustment

postoperative weight bearing