Sam Akhavan, MD
Pittsburgh Orthopaedic Sports Medicine Doctor
Arthroscopy Surgeon for Knee & Shoulder Surgery, Pain and Injuries
Arthritis is a difficult problem to manage in a young, active population. In most cases, younger patients are not candidates for knee replacement surgery due to the short lifespan of these implants in a young and active population. In a select groups of patients, high tibial osteotomy may result in significant pain relief and an ability to maintain an active lifestyle despite the presence of osteoarthritis.
A High Tibial Osteotomy is a procedure that involves a re-alignement of the lower extremity by making a controlled cut in the tibia (the larger bone of the lower leg). The cut is opened in a precise manner using wedges. Bone graft is placed in the opening and an implant is used to maintain the opening while it heals to the implant.
It is important to remember that a High Tibial Osteotomy is not for everybody. The procedure is reserved for younger, active patients with osteoarthritis limited to one compartment of the knee (medial or inside compartment) and malaignment of the leg. The procedure requires 6-12 weeks of limited activity (including a period of non-weightbearing on the leg) to allow the wedge to heal. In addition, therapy may be required for 6-9 months following the surgery as the body readjusts to the new alignment of the leg
A common complication of the High Tibial Osteotomy procedure is the irration that is commonly caused by the metal plates and screws used to maintain the opening wedge. Dr. Akhavan uses a new system for High Tibial Osteotomy that involved the use of a low profile, non-absorbable implant that does not cause irritation as the typical plates and screws. In addition, the system has a protective jig that protects the knee during the procedure and minimize the change of neurovascular injury
Dr. Akhavan performs the High Tibial Osteotomy procedure at Allegheny General Hospital in Pittsburgh, PA. The procedure involves an overnight stay at the hospital and is most often performed with a lower extremity block (a procedure that numbs all the nerves of the leg) to minimize the amount of post-operative pain.
Implant used for maintain the opening during a High Tibial Osteotomy. The implant is non-absorbable and is made of a PEEK (polyetheretherketone)
Picture representation of a High Tibial Osteotomy. Notice the cut made in the bone is wedged open. Bone graft has been placed within the wedge. The bone graft will eventually result in healing of the osteotomy
Preoperative Long Leg Films of a patient prior to high tibial osteotomy. The red line represents the portion of the knee that is loaded with weight bearing. Notice that the inside portion of the knee seems to be overloaded
The same patient after High Tibial Osteotomy. Notice that the weight-bearing axis of the knee is much better centered
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