Lateral Closing Wedge High Tibial Osteotomy—Technique and Outcomes

CW-HTO is a powerful surgical procedure used to treat symptomatic varus deformity in the knee, particularly when associated with medial compartment OA, meniscal injuries, or cartilage defects. In order to realign the mechanical axis of the knee, a wedge of bone is surgically removed from the lateral aspect of the proximal tibia, reestablishing the coronal alignment and the weight-bearing force distribution of the knee. It is important to take several factors into consideration when determining if LCW-HTO would be a beneficial procedure for each patient, as these factors may greatly influence surgical outcomes and functional improvement. Such factors may include patient-related factors such as chronologic age, BMI, level of sporting activities, and patient expectations, as well as preoperative knee-related factors, such as ligamentous stability, posterior tibial slope, TT-TG, joint line obliquity, and leg length. With the correct indications and when performed correctly, this joint preserving procedure provides significant improvement in knee pain and function, which has been shown to delay the need for knee arthroplasty and enable patients to return to work and sporting activities, improving patients’ overall quality of life.