Review Article

The Role of High Tibial Osteotomy in the Varus Knee

Rossi, Roberto MD; Bonasia, Davide E. MD; Amendola, Annunziato MD

From the Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy (Dr. Rossi), and the Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA (Dr. Bonasia and Dr. Amendola).

Dr. Amendola or an immediate family member serves as a board member, owner, officer, or committee member of the American Board of Orthopaedic Surgery, the American Orthopaedic Society for Sports Medicine, and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; has received royalties from Arthrex and Arthrosurface; serves as a paid consultant to or is an employee of Arthrex and Zimmer; serves as an unpaid consultant to MTP Solutions; and has stock or stock options held in Arthrosurface and MTP Solutions. Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Rossi and Dr. Bonasia.

J Am Acad Orthop Surg 2011;19: 590-599

American Academy of Orthopaedic Surgeon 19(10):p 590-599, October 2011.

Abstract

High tibial osteotomy (HTO) is a widely performed procedure, and good results can be achieved with appropriate patient selection and precise surgical technique. Clinical indications include varus alignment of the knee associated with medial compartment arthrosis, knee instability, medial compartment overload following meniscectomy, and osteochondral defects requiring resurfacing procedures. Coronal alignment (ie, varus, valgus) and sagittal alignment (ie, tibial slope) should be thoroughly evaluated in all cases. Many techniques have been described for HTO, whether alone or in combination with other procedures (eg, anterior cruciate ligament reconstruction, meniscal transplant, cartilage resurfacing). Little direct evidence exists regarding the effectiveness of HTO alone or in combination with other procedures because of the lack of randomized controlled studies. However, it is commonly accepted that correct alignment is essential in achieving durable results.