Course Lecture Pearls: Advanced Knee-Patellofemoral-HTOs_ Technique Options & Avoiding Complications-Faculty Lecture

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

Video Transcription

Video Summary

The speaker shares practical pearls from decades of experience with high tibial osteotomy (HTO), emphasizing its expanding role beyond osteoarthritis into instability and sports procedures (ACL issues, meniscal root repairs, OATS, transplants) where malalignment can cause soft-tissue or cartilage work to fail. Patient selection is key: younger, active patients with lower BMI, and avoiding cases with stiffness, advanced multi-compartment disease, significant patellofemoral OA, smoking/diabetes, older age, or subluxed “pothole” knees. Proper standing OA radiographic series and hip-to-ankle films are essential; MRI is mainly for assessing instability or the opposite compartment. Planning rules include limiting tibial correction angles (about ≤12°), avoiding large opening corrections (>10 mm/°) that risk peroneal nerve tension and rotational control issues, considering femoral/biplanar approaches for big corrections or patella baja, and managing slope carefully in ACL-deficient knees. Intraoperatively: position for fluoroscopy, sparing periosteum, protect posterior structures with retractors, prefer osteotome posteriorly for safety, open slowly and posteriorly, choose fixation based on correction size/BMI. Post-op: prevent hematoma, use aspirin prophylaxis, brace selectively, cautious weight-bearing, and early ROM with full extension.

Keywords

High tibial osteotomy (HTO)

Knee malalignment correction

Patient selection criteria

Preoperative radiographic planning (hip-to-ankle films)

Tibial slope management in ACL-deficient knees