title: A novel closed-wedge high tibial osteotomy procedure to treat osteoarthritis of the knee: hybrid technique and rehabilitation measures.
abstract: High tibial valgus osteotomy (HTO) is an established treatment for medial-compartment osteoarthritis of the knee. We have combined medial open and lateral closed-wedge HTO (hybrid closed-wedge HTO) to overcome the limitations of traditional closed-wedge HTO. Our new hybrid procedure has the following advantages: (1) the bone block removed is smaller in size; (2) the procedure yields optimal geometric characteristics for bone healing; (3) there is no step-off at the lateral osteotomy site; (4) the lateral cortex of the proximal and distal fragments is attached firmly by the oblique osteotomy; and (5) early full weight-bearing walking is possible. This procedure is effective in treating medial-compartment osteoarthritis accompanied by patellofemoral osteoarthritis. The indications for this procedure include a willingness and ability to comply with the postoperative rehabilitation program; a diagnosis of either medial-compartment osteoarthritis or complicated patellofemoral osteoarthritis; and preferably, an age of 70 years or younger, although this is not a strict constraint. Patients are permitted to stand using both legs on the day after surgery and walk with full weight bearing within 2 weeks of undergoing our novel HTO procedure. We describe the details of this surgical technique and the postoperative rehabilitation program for the patients who undergo this treatment.
authors.affiliation: Department of Joint Surgery Center, Yokosuka Municipal Hospital, Yokosuka, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Takeuchi
authors.affiliation: Department of Joint Surgery Center, Yokosuka Municipal Hospital, Yokosuka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Joint Surgery Center, Yokosuka Municipal Hospital, Yokosuka, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Miyasaka
authors.affiliation: Department of Joint Surgery Center, Yokosuka Municipal Hospital, Yokosuka, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sasaki
authors.affiliation: Department of Joint Surgery Center, Yokosuka Municipal Hospital, Yokosuka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuniya
authors.affiliation: Department of Orthopaedic Surgery, Shyonan Daiichi Hospital, Fujisawa, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Tsukahara