AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 2C: Knee Osteotomy

Video Transcription

Video Summary

The session focused on osteotomy principles, advancements, and debates in knee joint preservation surgery, highlighting its growing prominence. Dr. Armando Vidal emphasized the importance of proper patient selection—active, healthy individuals—and thorough preoperative deformity analysis using mechanical axis and joint line measurements to avoid over- or under-correction and complications such as nonunion or neurovascular injury. He outlined surgical techniques, including whether to preserve or cut the medial collateral ligament, and advocated for rigid fixation and bone grafting.<br /><br />Dr. Anil Ranawat advocated patient-specific instrumentation (PSI) as a revolutionary technology enhancing accuracy, safety, efficiency, and versatility in osteotomies. PSI integrates 3D imaging and digital templating to precisely guide cuts and hinge positions, potentially reducing radiation exposure and operative time without increasing costs. Studies showed fewer complications and more accurate corrections using PSI compared to freehand techniques.<br /><br />The choice of osteotomy site (femur, tibia, or both) depends on the location and degree of deformity. Drs. Travis Mack and Michael Lee discussed correcting varus and valgus deformities with single or double-level osteotomies, stressing accurate deformity localization to avoid joint line obliquity.<br /><br />Debates addressed medial opening wedge, supratubercle, trans-tubercle, and infratubercle slope correction osteotomies, with safety, fixation strength, and effects on patellar height weighing into surgical approach selection.<br /><br />Finally, a discussion compared high-tibial osteotomy (HTO) versus unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis. HTO offers durable correction with high return-to-activity rates and easier conversion to total knee replacement, while UKA provides quicker recovery and functional improvements but higher revision risks, making patient selection critical.<br /><br />Overall, osteotomies are essential tools in joint preservation, increasingly aided by technologies like PSI, with ongoing refinement of techniques and indications improving outcomes.

Asset Caption

Introduction by Moderators: Armando F. Vidal, M.D., Cassandra A. Lee, M.D.

Keywords

osteotomy

knee joint preservation

patient selection

preoperative deformity analysis

mechanical axis

medial collateral ligament

rigid fixation

bone grafting

patient-specific instrumentation

3D imaging

varus and valgus deformities

high-tibial osteotomy