Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome

We have analysed retrospectively the influence of different sources of knee deformity on failure of closing wedge high tibial valgus osteotomy (HTO). Preoperative frontal plane varus deformities of the lower extremity, distal femur and proximal tibia, and medial convergence of the knee joint line were assessed on a standard whole leg radiograph in 76 patients. Using the logistic regression model, the probability of survival for HTO was 77% (SD 4%) at 10-years follow-up. Varus deformity of the lower extremity ( 3 degrees ) were identified as preoperative risk factors for conversion to arthroplasty (P = 0.03 and P = 0.006). We found no evidence that varus inclination of the proximal tibia or distal femur influences long-term survival of HTO

Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus?

High tibial osteotomy (HTO) is commonly used for genu varum deformity in young and active patients. Corrective valgus osteotomy may however lead to an oblique joint line in cases of associated femur varum or absence of tibia vara. The over-correction, needed to obtain good long-term clinical results, may increase the obliquity even more. To avoid this drawback, the authors suggest use of an accurate and reproducible radiological protocol including at least a standing AP long-leg X-ray to measure not only the hip–knee–ankle (HKA) angle but also the medial distal femoral mechanical angle (MDFMA) and the medial proximal tibial mechanical angle (MPTMA). These measures will guide the surgeon to choose the best indication, including HTO, double level osteotomy (DLO) and distal femoral osteotomy (DFO). Computer-navigation of the osteotomies is the best choice to achieve the preoperative goal. This paper will present the pre- and perioperative protocols of HTO and DLO and the rationale behind this way of thinking