HTO & UKA Surgeries

What is HTO?

HTO is a surgical procedure that involves cutting and reshaping the upper part of the tibia (shinbone) to correct alignment issues in the knee joint. This can help redistribute weight from an affected compartment of the knee to the healthier side, thereby relieving pain and delaying the progression of osteoarthritis.

Indications for HTO:

• Early to Moderate Osteoarthritis: Particularly in the medial (inner) compartment of the knee.
• Varus Deformity: Often referred to as “bow-legged,” where the knee angles outward.
• Young and Active Patients: Typically performed in younger patients whose knee condition is not yet severe enough to require a total knee replacement.

Procedure Overview:

1. Anesthesia: The surgery is usually performed under general or regional anesthesia.
2. Incision: An incision is made over the knee to expose the tibia.
3. Osteotomy: The tibia is cut and reshaped to shift the weight-bearing line from the damaged compartment to the healthier compartment.
4. Fixation: The bone is stabilized using plates, screws, or other fixation devices.
5. Closure: The incision is closed and bandaged.

Benefits of HTO:

• Joint Preservation: It helps preserve the knee joint, delaying the need for knee replacement.
• Improved Alignment: Correcting alignment can alleviate pain and improve function.
• Rehabilitation Potential: Many patients experience significant improvements in mobility and reduction in pain.

Challenges:

• Recovery Time: HTO requires a rehabilitation period, with weight-bearing restrictions that can last several weeks.
• Complications: Possible risks include infection, blood clots, and issues with bone healing.
• Outcomes: While many patients benefit, results can vary based on individual factors, including age, activity level, and severity of osteoarthritis.

Unicompartmental Knee Arthroplasty (UKA)

What is UKA?

UKA, also known as partial knee replacement, involves replacing only one compartment of the knee (medial, lateral, or patellofemoral) with an artificial implant. This procedure is typically less invasive than a total knee replacement and aims to maintain more of the natural knee structure.

Indications for UKA:

• Unicompartmental Osteoarthritis: Significant arthritis localized to one compartment of the knee.
• Knee Deformities: Such as alignment issues that are limited to one side of the knee.
• Younger or Low-Activity Patients: Patients who are not candidates for total knee replacement due to age or activity level.

Procedure Overview:

1. Anesthesia: Similar to HTO, UKA is performed under general or regional anesthesia.
2. Incision: A smaller incision is made over the affected knee compartment.
3. Bone Preparation: The damaged cartilage and bone are removed from the affected compartment while preserving healthy bone and cartilage in the other compartments.
4. Implant Placement: A prosthetic implant is then placed into the prepared area.
5. Closure: The incision is closed, and a sterile dressing is applied.

Benefits of UKA:

• Minimally Invasive: Smaller incisions generally lead to less soft tissue trauma and faster recovery.
• Preservation of Function: Retaining the unaffected compartments allows for better overall knee function.
• Shorter Rehabilitation: Many patients can bear weight and engage in physical therapy sooner than with total knee replacements.

Challenges:

• Indications: UKA is only suitable for specific patients with unicompartmental disease.
• Complications: Risks include infection, implant failure, and stiffness in the knee.
• Revision Rate: Unicompartmental implants may have a higher revision rate than total knee replacements, especially if the disease progresses in the other compartments.

Comparative Considerations

Recovery and Rehabilitation

• HTO: Recovery generally involves a longer rehabilitation period and gradual return to weight-bearing activities, often necessitating the use of crutches for a few weeks.
• UKA: Rehabilitation is usually quicker, with some patients regaining a functional range of motion and the ability to bear weight within the first weeks post-surgery.

Conclusion

Both High Tibial Osteotomy (HTO) and Unicompartmental Knee Arthroplasty (UKA) are valuable surgical options for patients suffering from knee osteoarthritis. The choice between the two depends on various factors, including the patient’s age, activity level, the distribution of arthritis, and the specific goals of treatment. A thorough evaluation by an orthopedic surgeon can help determine the most appropriate procedure to relieve pain, improve function, and enhance the quality of life for individuals with knee issues.