Medial Opening-Wedge High Tibial Osteotomy

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Sports Medicine

Background:

• Mechanical axis deviation (MAD) causes abnormal knee joint loading, leading to cartilage degeneration, gait issues, and reduced mobility.
• Varus MAD, often centered in the proximal tibia, can be corrected with a medial opening-wedge high tibial osteotomy (MOWHTO).
• This procedure aims to reduce medial knee compartment stress, improving pain, function, and quality of life.

Purpose of the Study:

• To describe the surgical technique and rationale for medial opening-wedge high tibial osteotomy (MOWHTO).
• To highlight MOWHTO as a joint-preserving alternative for correcting varus knee malalignment.
• To compare MOWHTO with other treatment options for knee deformities.

Main Methods:

• Preoperative assessment includes patient history, physical examination, and radiographic analysis (hip-to-ankle AP, knee AP/flexion/lateral views) to determine the center of rotation and angulation (CORA).
• The surgical technique involves a medial approach to the proximal tibia, a biplanar osteotomy, opening of the wedge, fixation with a plate and screws, and closure.
• Key considerations include careful preoperative planning, intraoperative alignment checks, and postoperative weight-bearing restrictions.

Main Results:

• MOWHTO normalizes knee joint loading, alleviating pain and improving gait.
• The procedure preserves the native knee joint, allowing for higher activity levels compared to total knee arthroplasty (TKA).
• The medial approach is technically simpler and safer than a lateral closing-wedge osteotomy.

Conclusions:

• MOWHTO is an effective joint-preserving procedure for correcting proximal tibia-based varus malalignment.
• It is particularly suitable for young, active patients aiming to delay or avoid TKA.
• Expected outcomes include pain improvement, balanced gait, and enhanced mobility, while preserving future TKA options.