Correct cutsCorrect cuts

PSPS

But medial laxityBut medial laxity

Revised with a TC3 Revised with a TC3 + lateral release+ lateral release

With still medial With still medial laxitylaxity

IA medial wedgeIA medial wedge

(to regain IA stability)(to regain IA stability)

+ Concomitant HTO+ Concomitant HTO

(to regain alignment)(to regain alignment)

Correction OsteotomyCorrection Osteotomy where ?where ? when ?when ?

at the site of the malunion :

" ideal" to correct all the components of the deformity

but : but : -long to heal at this age!-long to heal at this age!-technique may be difficult -technique may be difficult (plane oblique)(plane oblique)

-fixation: plate, locking IM rod-fixation: plate, locking IM rod-often hypocorrection-often hypocorrection

impossible

- previous infection

- age

sometimes, easier to perform sometimes, easier to perform a a metaphyseal osteotomymetaphyseal osteotomy

closing or opening wedgeclosing or opening wedge

fixation if concomitant :• with the prosthetic stem• ± staple, plate, tibial tubercle osteotomy

when you plan a when you plan a concomitant concomitant osteotomy with TKAosteotomy with TKA

for malunionfor malunionwith good collateral with good collateral ligtsligts

Plan :Plan : first intraarticular surgeryfirst intraarticular surgery (prosthesis)(prosthesis) and then perform and then perform osteotomyosteotomy

preoperative Xray planning preoperative Xray planning with templates ++ (stems)with templates ++ (stems)

Post HTOPost HTO

Watch out !Watch out !

LCLLCL

FIRSTFIRST Forget the deformityForget the deformity just think of just think of IA surgeryIA surgery and implant the and implant the

prosthesis with reference to the prosthesis with reference to the ligaments and the articular sufacesligaments and the articular sufaces

Cuts // articular surfacesCuts // articular surfaces flexion & extension gapsflexion & extension gaps knee mobile & stable knee mobile & stable but malalignedbut malaligned

elevate the tibial elevate the tibial tubercletubercle

make a proximal make a proximal tibial cut // tibial tibial cut // tibial plateauplateau

a distal tibial cut a distal tibial cut perpendicular to perpendicular to the mechanical the mechanical axis with the axis with the tibial cutting tibial cutting guideguide

//

And close the wedge

Until flush with the tibial cutting guide

• long stem• tibial tubercle,

2 screws• ± screws,

plate, staple