AANA Lab Course 913 - Advanced Knee Course-HTOs_ Technique Options & Avoiding Complications Faculty Lecture

HTOs_ Technique Options & Avoiding Complications Faculty Lecture_ Mark A. Heard, MD

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This document outlines the approach to High Tibial Osteotomy (HTO), focusing on patient selection, preoperative planning, operative technique, and postoperative care.<br /><br />Indications for HTO primarily include unicompartmental osteoarthritis, instability addressed by sagittal plane osteotomies, and unloading procedures such as OATS or meniscal transplantation. Ideal candidates are young, active patients with unicompartment disease who have not improved with conservative treatment. Relative contraindications include high BMI, range of motion loss, patellofemoral osteoarthritis, subluxation, diabetes, and age over 60.<br /><br />Preoperative imaging is critical and includes a standard osteoarthritis series (standing AP at 0° and 30°, lateral, and skyline patella views), three-foot films for mechanical axis and leg length, and MRI to assess compartment loading and structural integrity. Special attention is paid to coronal tibial slope (aiming for about 12°), mechanical axis alignment, patellar position (noting patella baja), and sagittal plane slope to guide surgical planning.<br /><br />The surgical setup involves patient positioning with or without a tourniquet due to arterial tension risk, and fluoroscopy for visualization. The operative technique emphasizes careful elevation of the patellar tendon fibers, protecting vascular structures, accurate pin placement from the pes anserinus to the tibial tubercle, and using an osteotome (not a saw) for controlled posterior cortex cuts while listening for cortical breach.<br /><br />Fixation involves a locking plate with approximately 7.5° of correction. Postoperatively, staples are used for drainage, aspirin 81mg twice daily for DVT prophylaxis, and bracing if the far cortex is breached. Weight bearing is limited to feather weight for non-locking and partial weight bearing for locking plates. Early range of motion and encouraging full knee extension are key to recovery.<br /><br />Overall, meticulous preoperative assessment, precise surgical technique, and structured postoperative protocols help optimize HTO outcomes and minimize complications.

Keywords

High Tibial Osteotomy

HTO

unicompartmental osteoarthritis

patient selection

preoperative imaging

operative technique

postoperative care

mechanical axis alignment

locking plate fixation

DVT prophylaxis