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Osteoarthritis of the knee is a debilitating disorder. A few years ago, treatment options were limited primarily to arthroplasty (joint replacement). While joint replacement remains the ultimate solution, it is typically recommended for patients over 60 years of age who do not place significant load on artificial joints.
For younger patients under 60, highly active individuals, or those involved in demanding sports, High Tibial Osteotomy (HTO) offers a valuable alternative. HTO is particularly beneficial for those experiencing knee pain during walking or prolonged standing and who are beginning to lose the cartilage cushion in the knee, as evidenced on X-rays.
The Problem with Cartilage Loss
When cartilage is lost, the bones in the knee joint start to grind against each other, causing pain and overloading one side of the joint. Many people tend to ignore the pain or rely on painkillers while continuing their daily activities. This neglect can lead to severe knee wear, leaving joint replacement as the only option. However, if addressed early with HTO, patients can achieve complete pain relief, slow down the degenerative process, and maintain an active lifestyle. HTO can delay or even eliminate the need for joint replacement surgery by up to 15 years.
The High Tibial Osteotomy Procedure
During HTO, the tibia is cut through a small 1 cm incision and straightened. The bone is then fixed using either an external fixator or a bone plate. The external fixator allows for gradual and precise correction post-surgery, while the bone plate helps maintain immediate correction. The hospital stay is about 5 days, and the procedure is virtually painless. HTO corrects joint load distribution, slows degeneration, and allows the cartilage to regenerate, restoring normal joint space over time.
HTO is similar to wheel balancing in vehicles. Just as misaligned tires need alignment correction rather than replacement, misaligned legs require corrective procedures to restore natural knee balance and function.
HTO has been described in medical literature since the 1950s, initially as a closing wedge osteotomy. This older technique involved removing a wedge of bone from the upper tibia and fibula, which could complicate future knee replacement surgeries. Consequently, HTO fell out of favor with many orthopedic surgeons, who believed its benefits lasted only 5-7 years.
Innovations at the Center for Limb Lengthening & Reconstruction
At the Center for Limb Lengthening & Reconstruction, Mangal Anand Hospital, Mumbai, we specialize in the minimally invasive open wedge technique for HTO. This method creates a gap that gradually fills with new bone, maintaining the bone's natural shape and avoiding complications for future knee replacements. Studies have shown that accurate correction within a narrow margin of 3-5 degrees can yield results lasting 15 years or more. We recommend using an external fixator for precise correction, ensuring long-lasting outcomes.
At our center, we utilize various methods to assist the open wedge technique, including:
- Tomofix Internal Fixation: A locking plate applied internally, leaving no external hardware visible.
- Hexapod Fixator: An external fixator with a six-axis correction system, offering advantages and disadvantages that can be discussed during consultation.
- Case Example: Varus Deformity Correction
Why Choose Mangal Anand Hospital?
Mangal Anand Hospital excels in orthopedic care, offering advanced treatments and personalized attention for knee osteoarthritis. Our experienced orthopedic specialists use the latest surgical techniques and state-of-the-art technology to ensure optimal outcomes. We are dedicated to improving your quality of life through effective and innovative treatments like HTO.
If you suffer from knee osteoarthritis, consult our experts at Mangal Anand Hospital to explore your treatment options. Early intervention with HTO can prevent further degeneration and help you maintain an active lifestyle. Choose Mangal Anand Hospital for exceptional orthopedic care and advanced surgical solutions.