High Tibial Osteotomy

Description

In this informative live surgery video, Dr. Rob Rozbruch, Chief of The Limb Lengthening and Complex Reconstruction Service at the Hospital for Special Surgery, presents a surgical correction of bowlegged deformity, also known as genu varum, in a 25-year-old male patient. The video outlines the patient's preoperative condition, including bilateral genu varum with complaints of knee pain and concerns regarding future arthritis.



Dr. Rozbruch details the surgical approach planned for this case, involving an opening wedge proximal tibial osteotomy with locked plate fixation, performed in a staged fashion. The focus is on the right side, exhibiting a mechanical axis deviation of 20 millimeters medial to the midline, indicating the need for correction. Various X-rays analyze the deformity and outline surgical planning, revealing a 6-degree deformity at the apex in the proximal tibia.



The surgical procedure incorporates a 7-centimeter incision, followed by dissection to expose the patellar tendon for optimal protection during the osteotomy. Utilization of specific tools and techniques, such as a micro sagittal saw and graduated osteotomes, are showcased as the surgeon carefully executes the osteotomy while ensuring the integrity of surrounding tissues.



Following retraction and precise cutting, a tricortical allograft strut is inserted for stability. The video demonstrates key steps, including the use of irrigation and bone grafting materials to support healing. Final steps of the procedure involve inserting a locked plate and confirming proper alignment through X-rays before closing the incision.



Post-operative protocols are discussed, emphasizing early mobilization and weight-bearing activities. The video concludes with post-operative X-rays showing significant correction of the bow leg alignment, alongside preoperative images for comparison. Dr. Rozbruch's presentation aims to educate viewers on the technical aspects and outcomes of this complex surgical procedure.

Specialties