Proximal Tibial Osteotomy using a Newclip plate
Subscribe to get full access to this operation and the extensive Knee Surgery Atlas.
Learn the Proximal Tibial Osteotomy using a Newclip plate surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Proximal Tibial Osteotomy using a Newclip plate surgical procedure.
High tibial osteotomy (HTO) is a well-established and commonly used treatment for younger and active older patients with medial compartment osteoarthritis of the knee and varus malalignment.
The aim of the HTO is to shift the mechanical axis from the medial to the lateral compartment in order to reduce pain and delay the application of a total knee replacement (TKR). The open wedge HTO technique via medial approach was first described by Hernigou et al. in 1987 and has subsequently become the preferred method of correction. Progression of damage to the joint surfaces due to overloading can be significantly retarded by realignment of the extremity with the aim of at least reducing the overload on the medial compartment to a value close to physiological. Further reduction of medial load by making the line of Mikulicz pass far lateral to the intercondylar eminence would only cause the lateral joint to suffer overload while taking the risk of knee knocking during ambulation. The amount of correction (valgisation) to be aimed at is still much debated. Fujisawa et al. reported good results when the Mikulicz line passed through a point between 30% and 40% lateral to the midpoint of the knee (total width of knee being 200%). Based on this, the term “Fujisawa point” has been coined, which is defined as 62% of the entire width, measured from the medial side. We advocate some overcorrection of the varus deformity to a level dependent on the severity of the medial pathology. In instability and the treatment of chondral lesions the correction is to the up slope of the lateral tibial spine. In osteoarthritis the correction is taken further to the tip or downslope of the lateral spine but not beyond the Fujisawa point.
Author: Professor Martyn Snow FRCS(Tr & Orth)
Institution :The Royal Orthopaedic Hospital, Birmingham ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.