Hybrid Protective Sentinel System: A Combined Technique for Safe and Controlled Open-Wedge High Tibial Osteotomy

Open-wedge high tibial osteotomy is an effective joint-preserving surgery for medial compartment osteoarthritis but remains associated with 3 major intraoperative hazards: posterior neurovascular injury, lateral hinge fracture, and unintended slope modification. The present technical note describes a hybrid method that integrates the protective cutting system and sentinel wires technique to achieve maximal procedural safety during open-wedge high tibial osteotomy.