Treating the Younger Degenerative Knee From Osteotomy to Arthroplasty (AANA22)-Assessing and Managing Complications of Osteotomy

Video Transcription

Video Summary

The speaker discusses complications in high tibial osteotomies (HTOs), emphasizing medial opening wedge osteotomies as safer and easier. Key advice includes selecting locking plate fixation over non-locking systems, handling soft tissues carefully, and using a retractor to protect neurovascular structures during bone cutting. They warn about rare vascular anomalies and stress caution in screw placement to avoid injury. Techniques to avoid patella baja and increased posterior slope changes are outlined. For large corrections, distal tubercle cuts can preserve patella height. Hinge fractures are managed with staples placed before opening the wedge. Fractures into the tibial plateau and non-unions are rare but treatable complications. The speaker refutes the myth that HTO compromises later knee arthroplasty outcomes. Grafting with allograft wedges and DBX is used to fill gaps in larger corrections. Panel discussions cover MCL management, patient-specific instrumentation limitations, and avoiding overcorrection in ligamentous laxity. Overall, HTOs are effective and safe when done with proper technique and awareness of pitfalls.

Asset Caption

Andreas H. Gomoll, M.D.

Keywords

high tibial osteotomy

medial opening wedge

locking plate fixation

hinge fracture management

patella baja prevention

vascular anomaly caution