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High Tibial Osteotomy (HTO)


Pre surgery
The clinical pics and full length x-ray before surgery show a significant varus deformity in both the tibiae. The right side was operated first as the right side was more painful. The yellow line on the x-ray shows the load bearing axis, which is passing through the inner side of the knee. The red and the green lines show the varus angulation (bowing of the leg).
 
 
 
 
Post Surgery
During the surgery the bone is cut (High Tibial Osteotomy) and the fixator is applied.
 
 
 
 
2 weeks post surgery
The gap at the osteotomy increases as distraction goes on, changing the angle with it.
 
 
 
 
3 Weeks of distraction – axes corrected
At the end of 3 weeks of distraction the correction is completed and angles are confirmed by the full length x-ray. The load bearing axis is now passing through the center of the knee joint as opposed to the inner side before surgery.
 
 
 
 
7 weeks
 
 
 
 
10 weeks
 
 
 
 
12 weeks post surgery – just before fixator removal
12 weeks post surgery the distraction gap is consolidated well and osteotomy is healed. Even though a slight gap is seen on the medial cortex (inner border on the left picture), other 3 sides have healed well and patient is walking comfortably bearing full weight.
 
 
 
 
4 weeks post removal
The x-rays and clinical pictures 4 weeks after fixator removal, showing excellent correction. The osteotomy has healed well. The patient is walking well without any trouble on the right side. The left side also has significant medial compartment osteoarthritis and joint space reduction alongwith varus deformity.
 
 
 
 
6 months post surgery
The X-rays 6 months after high tibial osteotomy, showing excellent correction of the right side, with maintenance of joint space. The left side is also troubling her, and is scheduled for surgery soon.