OrthoNet

HTO-complications2
Persistent pain
- the most important determinant of sustained pain relief is accuracy of correction
- patients with > 15 of varus will likely do poorly, because you will not get them over farenough.
- also, patients with a high adductor moment may not do as well

Patient Selection
- what side is the angular deformity on.
- varus closing wedge osteotomies do poorly for valgus knees - the joint line is made oblique, the nerve is stretched, and if the MCL is stretched out, the closing of the medial side will simply make this more loose - DO THE VALGUS KNEE FROM THE FEMORAL SIDE.
- if there is significant MCL laxity in the varus knee, consider medial OPENING wedge osteotomy
- avoid inflammatory arthritides

Preoperative planning

- beware the calculation of correction based on angles alone. In a short person, a 15o wedge will not create a greater change than in a tall person!
- Try to consider where the osteotomy will put the mechanical axis - it should be shifted into the medial one third of the lateral compartment, approximating a 183 to 185 degree valgus weightbearing axis.