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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