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VALGUS-PRODUCING OSTEOTOMY OF THE UPPER TIBIA

Method
Valgus-producing medial opening osteotomy for a deviation of the axis
Duration
90 minutes
Recovery time
4 to 6 months

The valgus-producing medial osteotomy of the upper tibia is an established surgical procedure for correcting bow legs (genu varum). With a bow leg, most of the load runs through the inner part of the joint – a deviation of only a few degrees is enough for the medial compartment to carry the greater share of the pressure. The operation shifts the mechanical axis of the leg outwards and so takes load off precisely the part that is bearing too much. The aim is to preserve your own joint and to slow the wear down.

It is considered above all for cartilage damage or early wear in the inner part of the joint – particularly in younger, athletically active patients for whom an artificial joint is not yet a sensible option. The realignment can be carried out on its own or alongside treatment of cartilage, of a meniscus or of a ligament: if the faulty loading remains, the restored structure soon comes under the same pressure again.

How the operation proceeds

After precise planning beforehand on the basis of full-length leg X-rays and, where needed, a 3D CT scan, the osteotomy is carried out under fluoroscopic control. A wedge-shaped gap is opened on the inner side of the upper tibia in order to correct the leg axis outwards (into valgus). The gap that this creates is filled with a bone graft or a spacer and fixed with a locking plate.

This technique allows the mechanical axis to be corrected exactly without touching the joint surfaces themselves. Depending on the findings it is combined in the same operation with further joint-preserving procedures – cartilage treatment, a meniscus repair or a ligament reconstruction, for instance.

Rehabilitation after an HTO

Aftercare proceeds step by step and is guided by the consolidation of the bone and by the restoration of loading along the leg axis. Mobilisation accompanied by physiotherapy is decisive for the functional result.

Phase I (0-6 weeks): partial weight-bearing and protection
  • Partial weight-bearing with forearm crutches (about 15-20 kg)
  • Orthosis to control movement, thrombosis prophylaxis where needed
  • Cooling, elevation, lymphatic drainage
  • Passive mobilisation exercises, CPM splint
Phase II (6-12 weeks): increasing load
  • Transition to full weight-bearing depending on the X-ray check
  • Strengthening the thigh and hip muscles
  • Increasing active movement, co-ordination training
Phase III (from week 12): everyday life and sport
  • Stability and load training
  • Sport-specific build-up training (from about 4-6 months)
  • Return to activity after clinical and radiological checks