151 / 242
151
Introduction
Medial knee osteoarthritis is not uncommon
and high tibial osteotomy (HTO) was described
for the first time more than 50 years ago [7, 9,
13]. Nowadays, HTO remains a good option [3,
4, 5, 8, 11, 17, 24, 27], despite the large
expansion of total knee replacement (TKR) or
the revival of unicompartmental knee prosthesis
boosted by the less-invasive surgery concept. It
is well indicated for “young” and active people
(less than 65 years of age) with moderate
arthrosis (narrowing joint line up to 100%
without any bone wear or instability).
Nevertheless it is a demanding surgery, which
exposes to excessive over or under correction
likely to lead quickly to failure [8, 24, 26] or
oblique joint line leading to more difficulties in
performing TKR (fig. 1). This oblique joint line
corresponds to an excessive valgus of the tibial
mechanical axis [1]. It is all the more frequent
when varus is important whether for a femoral
or a femoral and tibial deformity. The desirable
overcorrection to achieve a good clinical result
(3 to 6°) increases even more this oblique joint
line. When it reaches 10° of valgus one must
often perform an osteotomy to set the tibial
mechanical axis back to 90° [14] before
implanting the prosthesis.
We thought for a long time that combined
femoral and tibial osteotomy was a suitable
procedure to avoid this drawback, but, because
of the difficulty to obtain an accurate lower leg
axis without any reproducible assistance, we
had performed it in only a few cases.
Double level osteotomy for
genu varum deformity
D. Saragaglia, M. Blaysat, M. Grimaldi
Fig. 1: Severe oblique joint line after high tibial
osteotomy. Notice the extreme tibial valgus.