High tibial osteotomy is an orthopaedic surgical procedure which aims to correct a varus deformation with compartmental osteoarthritis. Since the inception of the procedure, advancements to technique, fixation devices, and a better understanding of patient selection has allowed HTO to become more popular in younger, more active patients hoping to combat arthritis. The idea behind the procedure is to realign the weight-bearing line of the knee. By realigning the knee, the force produced from weight-bearing is shifted from the arthritic, medial compartment to the healthy, lateral compartment. This decrease in force or load in the diseased part of the knee joint decreases knee pain and can delay the development or progression of osteoarthritis in the medial compartment. The general surgical technique includes either performing HTO alone or performing HTO in combination with ligament reconstruction. When deciding which treatment avenue to take, one must consider patient demographics, their predominant symptoms, and which ligaments, if any are involved. When ligaments are involved, but the ACL deficiency is chronic and pain is due to arthritis and malalignment, HTO alone should be sufficient.
High Tibial Osteotomy
Knee Preservation Surgery
Knee preservation surgery encompasses a range of surgical techniques aimed at treating knee joint conditions, particularly osteoarthritis, in a way that maintains as much of the natural knee structure as possible. These surgeries are designed to alleviate pain, improve function, and delay the need for more invasive procedures like total knee replacement. Minimally invasive surgery using a small camera (arthroscope) and instruments inserted through tiny incisions. Typically quicker than open surgery, with patients often resuming normal activities within weeks. Cutting and realigning the bones to redistribute weight and relieve pressure on the affected knee compartment. Harvesting and culturing cartilage cells from the patient, then re-implanting them into the defect. Transferring healthy cartilage and bone from one area of the knee to the damaged area. Generally quicker and less painful than total knee replacement, with many patients returning to normal activities within a few months. Knee preservation surgeries can be highly effective for the right patients, particularly those who are younger and more active, providing a means to manage knee problems while maintaining natural joint integrity for as long as possible.
Limb lengthening
Limb lengthening is a surgical procedure used to increase the length of a limb, typically the legs, in individuals with limb length discrepancies or short stature. Uses an external fixator device attached to the bone with wires or pins. The device gradually pulls apart bone segments, stimulating new bone formation in the gap created. Involves implanting telescopic rods inside the bone. These nails can be adjusted remotely using magnets to gradually lengthen the bone. The bone segments are gradually pulled apart at a controlled rate (typically 1mm per day) to encourage new bone growth in the gap. After reaching the desired length, the bone segments are allowed to consolidate and harden. Physical therapy is crucial to maintain joint mobility and muscle strength during and after the lengthening process. Weight-bearing and activity level are gradually increased as bone healing progresses. In individuals with a desire for increased height beyond what is achieved naturally. When one leg is shorter than the other, causing gait abnormalities or functional limitations. Limb lengthening is a complex procedure that requires careful planning, skilled surgical technique, and dedicated post-operative care.
