What is an osteotomy (HTO, high tibial osteotomy)?
In patients who have arthritis on only the inside or the outside of the knee, and the rest of the knee is normal, an osteotomy is occasionally performed. This is generally performed in patients who are too young for total knee replacement. This procedure is performed to take the pressure off of the area of the knee with arthritis.
A wedge of bone is generally added to the shinbone in order to realign the knee. Depending on the type of osteotomy, a bone graft from the hip may also be required to help the osteotomy heal. Sometimes, a wedge of bone is removed from the outside of the knee to perform the osteotomy. This procedure provides good pain relief for approximately 80% of patients up to 10 years.
Factors increasing risk of infection
- Obesity is associated with a higher risk of infection. Individuals with a body-mass index (BMI) >35 had a 2.1 times greater risk of infection compared with those with a lower BMI
- patients with osteonecrosis and rheumatoid arthritis had a 2.2 times greater risk of infection compared with those with osteoarthritis.
- previous infection of the joint
- tooth infection : a visit to dentist & panoramic dental X-Ray, and treatment of dental problems are necessary to eliminate a potential risk of infection.
Even with a carefull act performed by perfectly trained team, any complications may happen the same as in every surgical act. These are exceptionnal, The list below is not exhaustive.
- Infection is one of the most dreaded complications. The efficacy of prophylactic measures and risk factors play an important role.
- prophylactic mesures: laminar flow, body suits, drains, surgical time (length), the use of preoperative antibiotics. detection and treatment of risk factors :- Obesity, diabetis, pre op treatment of dental or urinary infection.
- Skin necrosis should well controlled with adapted local healthcare . Its prevention is realised with a central skin incision. If not controled, the risk is to transmit an infection to the prosthetic joint. A reoperation is necessary.
- Neuro-algodystrophy : rare ( 1 à 3% ) but impossible to plan ( except in case of previous episode) and difficult to treat.
- un syndrome des loges : may happen in closed wedgeosteotomy technique as the muscle and lateral aponevrosis of the leg are opened.
- delay or non union : rare in this metaphyseal bone area, iIt may break the plate and needs an other operation.
- tibial plateau fracture when opening the osteotomy. It may delay the bone healing.
- Partial peroneal palsy in case of traumatism of the motor branch of the extensor hallucis longus during lateral approach in closing HTVO.
- femoro-cutane nerve palsy when harvesting graft on iliac crest.
- pain at iliac crest harvesting zone.
- hematoma at iliac crest harvesting zone.
- pain on osteosynthsis material some months later : removal is possible at 6 months.
- phlebitis : preventive mesure ( early mobilisation, anti-thrombotic socks, low Weight Molecular Heparin anti-embolic prophylaxis for 6 weeks) and systematic echodoppler control at 7th day allow the risk to be minimize ; in case it happens, an anticoagulation treatment is started and rehabilitation is slowered.
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