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High Tibial Osteotomy

  1. Biomechanics
    1. In normal knees, 60% of load passes through medial compartment.
    2. Varus and valgus deformities are common and cause an abnormal distribution of weight bearing stresses within the joint.
    3. Most common deformity in patients with OA of knee is a varus position, which causes stress to be concentrated medially, accelerating degenerative changes in medial part of joint. Valgus deformity accelerates changes on lateral compartment.
  2. Principle
    1. Biomechanical rationale for proximal tibial osteotomy in patients with unicompartmental osteoarthritis of knee is unloading of involved joint compartment by correcting the malalignment and redistributing the stresses on the knee joint.
    2. Osteotomy (corrective) is performed through cancellous bone near joint line to offer advantages of higher healing rates and to achieve better joint line inclination and limb alignment.

HTO (High tibial osteotomy)


UKA (Unicompartmental knee arthroplasty)


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Total knee arthroplasty


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Hip arthritis

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Total hip replacement (THR)

  1. Indications
    1. Pain & disability resulting from OA that significantly interfere with high demand employment or recreation
    2. Evidence on weight bearing radiographs of degenerative arthritis that is confined to one compartment with a corresponding varus or valgus deformity
    3. The ability of patient to use crutches after the operation and the possession of sufficient muscle strength and motivation to carry out a rehabilitation program.
    4. Good vascular status without serious arterial insufficiency or large varicosity.
  2. Contraindications
    1. Narrowing of lateral compartment cartilage space.
    2. Lateral tibial subluxation of >1cm
    3. Medial compartment bone loss of> 2or 3mm
    4. Flexion contracture of> 15 degrees
    5. Knee flexion of <900
    6. More than 200 correction needed
      - Rheumatoid arthritis




Age & activity

<65 years & active
>65 years but physiologically young & active

Sedentary patient >65 years of age

Arthritis type


RA or other inflammatory arthritis Bicompartmental osteoarthritis

Morbid obesity



Bone loss (medial Libial platue)

<1 cm

> 1cm

Varus deformity

<15° (ideally <10°)


contracture or extension defecit

<15 degrees


Arc of motion



Tibial subluxation (lateral) or varus thrust

<1 cm


Valgus deformity





Instability (i.e. ACL tear etc)

Osteochondral injury involving

<1/3 surface <5mm deep

> 1/3 surface
>5 mm deep

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