Chiba osteotomy - indication and technique
ESSKA Academy. Kuwashima U. Nov 8, 2019; 284374; epEKA-34 Topic: Arthroscopic Surgery
Dr. Umito Kuwashima
Dr. Umito Kuwashima
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Chiba osteotomy - indication and technique

ePoster - epEKA-34

Topic: HTO

Kuwashima U.
Tokyo Women's Medical University, Department of Orthopaedic Surgery, Tokyo, Japan

Chiba osteotomy (tibial condylar valgus osteotomy: TCVO) is a type of open wedge osteotomy (OWHTO) that was developed by Chiba G et al. in 1990 in Japan. The strategy of TCVO is to obtain the joint stability and congruity. TCVO can adjust not only the varus deformity but also the joint surface. The most important factor for the postoperative good outcome is the strict indication.
The indication of this osteotomy are as follow: middle to end-stage medial unicompartmental osteoarthritis (OA) (Kellgren-Lawrence grade III / IV) with the deformity of joint surface (“Pagoda type” deformity), the joint line convergence angle (JLCA) > 3° (>5° is much better), range of motion >90° and flexion contracture < 10°.
For the surgical technique, L-shaped osteotomy is performed from medial side of proximal tibia to the lateral beak of the intercondylar eminence. The apex of the L-shaped osteotomy line is on the medial border of the patellar tendon insertion. Surgeons should note the direction of the chisel during the osteotomy to the intercondylar eminence. Because TCVO can improve the JLCA, which cause the postoperative overcorrection, the postoperative % mechanical axial deviation (%MAD) is set to 60% from the edge of medial plateau. The spreader should be put at the posterior cortical bone to avoid the increase of tibia slope. The locking plate can stabilize the osteotomy reliably and help shortening the period of postoperative rehabilitation.
The advantages of TCVO are (1) the subluxation of lateral joint can be reduced, (2) joint congruity can be improved, which result in the improvement of joint stability, (3) early weight bearing can be started with the locking plate because of not cutting the lateral tibial condyle and (4) the effect to the patellofemoral joint may be minimal compared to OWHTO. On the other hand, the disadvantage of TCVO is the limited angle of valgus correction. TCVO can correct to valgus only up to the point where the lateral joint line of femur and tibia are parallel. If more valgus correction are needed, surgeons should consider to add OWHTO.
TCVO may be useful surgical option in patients with advanced knee OA and lateral joint laxity.
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