Upper Tibia OsteotomySingle incision & MIS

H.Makhmalbaf MDConsultant Orthopaedic & Knee

Surgeon Mashad University

History:

• Coventry 1965• Long incision• Exposure of the proneal nerve• Osteotomy of the head of Fibula• Reattachment of the conjoined tendons• Closed wedge osteotomy of tibia• Fixation with stepped staples & POP

Other techniques

• Dome shaped osteotomy (fibular shaft)• Gradual correction with open wedge & Ex-fix• Open wedge & plate fixation• Closed wedge & plate fixation + or - POP • Pitfalls of each technique

Complications of UTO

• Undercorrection or overcorection• Loss of correction • Delayed union or non-union• Nerve injury, vascular injury• Compartment syndrome• Implant failure

Complication of UTO

• Penetration of the knee joint by implants• Tibia & fibula fracture• Fibula non-union• Fracture of the proximal fragment of tibia• DVT& PE• Infection • Jeoperdy of future surgeries

What is best:

• Less invasive & minimal incision• Avoid proneal nerve• No fibular shaft osteotomy• Single incision away from future TKR incision• No metalwork ,less exposure, less infection• No second operation for removal of implant• Less expensive

Pitfalls:

• POP for 6 weeks• Limitation of ROM of the knee• LCL laxity?• Higher rate of VTE?

Previous study results:1382

• 21 patients,22 knees, 8 male, 13 female• Age; 16-65, cc: was pain + deformity• Med compt. OA in 11, PFJ involvement in 4• No OA in 6

Results :

• Excellent in 3• Good in 11, Fair in 6, Poor in 1• Better results in men• Better results in under 60 & 40y• BMI affects the results directly• Indexes: Pain, loss of correction, opening of

medial joint space, no deterioration of OA

Complications:

• Loss of correction, 6 deg in 14 pts.• Paresthesia in foot 6 pt• No non-union• Superficial infection in 1

UTO scar

Previous UTO

Modified technique

Surgical incision

Exposing tibia

Patella tendon lifted up

Fibula osteotomy

Tibia osteotomy:

Completion of osteotomy

Wedge removal

Wedge outside osteotomy

Fixation with staples

Placing the staples

Before closure

After closure

POP applied

Pre & Post op:

Bilateral 2 stage UTO

R leg modified Coventry

Walking shoe

Thank you