Abstract
Knee varus deformity is a condition where the mechanical axis of the lower extremity
is displaced medially. As a result, the medial compartment of the knee is overloaded
and is prone to degenerative changes. The mechanical compromise of the medial compartment
of the knee is very disabling, especially if affecting young and active individuals.
Valgus-producing high tibial osteotomies (HTOs) were designed to shift the mechanical
axis laterally, transferring the load to the knee compartment which is asymptomatic.
HTO is a well-accepted concept for the management of medial unicompartmental knee
arthritis. Medial joint line pain associated with metaphyseal varus deformity in a
young patient is the essential criteria to indicate an HTO. Symptomatic young patients
who do not have a bone-on-bone pathology may be benefited from HTO since for those
individuals a unicompartmental knee replacement is contraindicated. Surgical technique
matters in cases of HTO. Dome, lateral closing wedge, and medial opening wedge techniques
have been reported with mixed results. Recent developments in fixation techniques,
namely, the development of implants with angular stability, introduced safety, and
reproducibility to open wedge HTOs, which became the preferred correction method for
varus deformity of the knee. This article aims to cover the indications and contraindications
of HTO with a focus on the unique aspects of the biplanar open wedge tibial osteotomy.
Keywords
knee arthritis - varus knee - high tibial osteotomy - open wedge osteotomy
