Ideal candidate for HTO

Hitesh exemplifies the active person under 65 who really can benefit from osteotomy surgery.

Hitesh  is a very pleasant 52 year old gentleman who presented to me a few weeks back with significant varus on the left and Grade IV bone-on-bone arthritis. He had always been very active but had got to the point where all activities of daily living had become painful and he could do very little. Walking was an issue. His pain was all on the inner aspect (medial) side of the knee because of the Grade IV osteoarthritis here. He ticked all the boxes for osteotomy surgery and, although we talked about all the different options he decided to go for this procedure which I carried out a month ago.

long leg post op hto
hto plate
hto

I am delighted to say that today in the clinic he was able to walk without crutches and has very little pain. He is thrilled that his knee which has been bowed and bent for many years is now straight and he can't believe that the surgery was done through a three centimetre incision using our minimally-invasive approach.

Discrepancy between X-ray and clinical findings

Again this is another case of a young active person who's done very well from osteotomy surgery and we need to be promoting this as there are som many people out there with a similar issue, particularly on the medial side of the knee. Vitesh fits very much into the so-called 'treatment gap' where he has full-thickness disease bone-on-bone arthritis but on the X-ray there is still some joint space visible implying from the films that it is only partial-thickness disease and really we have no other options available other than injections. 

Hitesh is the sort of patient that many surgeons would turn away and say he was "too young for a knee replacement" and to "come back later". But these are the perfect patients for osteotomy surgery and we really need to be thinking about this option more and more in this active younger population.

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