Unusual closing wedge HTO


David is a 43 year old gentleman who works in IT in a fairly physical job. He is very fit in himself, enjoying exercise and also doing things with his two young children.

 Prior to his injury David enjoyed a long 60 mile cycle at least once a week, but sadly was hit by a car back in February 2017, suffering a lateral tibial plateau fracture which was fixed very nicely by Mr Vipul Mandalia in Exeter. Unfortunately he went on to develop ongoing sharp pains and things weren't settling so he was referred through to our osteotomy centre in London.

Alignment issue after road traffic accident

In terms of his alignment I found him to be neutral on his left and valgus on his right (left of this illustration) due to his lateral tibial plateau injury. We discussed the case together, and were very fortunate to have Ronald van Heerwaarden (who is probably currently the best known osteotomy surgeon globally) join our group in London, and actually Ronald was able to be there at the surgery last Friday when we did a rather rare operation - doing a closing wedge medial osteotomy in the proximal tibia of the right knee to bring his right knee back into varus. We chose the tibia as opposed to the more conventional femur because the correction would benefit him both in flexion and extension where his original issues were.

High tibial osteotomy post op

The surgery went extremely well and I am delighted that a week down the line David is smiling and reports he has absolutely no pain at rest, and is able to bend his knee comfortably to 100 degrees.

It's great that we are collaborating with Ronald - and soon we will have Kristian Kley also join our group and will be doing surgery, and we truly do have a centre of excellence for osteotomy. Hopefully in the not too distance future we will be considered the global centre for deformity osteotomy surgery.

Testimonial from David

I was hit on the right side by a car while out cycling in Feb 2017. My right knee was badly broken in a number of places and was pinned back together with various bits of metal and a bone graft. After recovering I was still having lots of issues. My right leg wouldn’t come through straight, both my knees kept getting sore after walking or cycling and my right knee was always trying to wobble inwards (not sure this is the correct technical term).

In June 2018 I saw a consultant knee surgeon called Dr Vipul Mandalia in Exeter who said that I would probably benefit from realignment surgery. He also said that I needed a second opinion as an insurance claim was involved and gave me Professor Wilsons details. He left it open as to who I had treatment with. After meeting Prof. Wilson I was really impressed with how carefully he went over everything and he said he thought that I would benefit from a new type of operation he was doing that was more likely to have a beneficial outcome. I then went to see Dr Khakha who Prof. Wilson performs the operations with. Again I was really impressed with both his technical knowledge and the time he took to carefully explain everything to me. They also said they would perform an arthroscopy on my left leg during the same operation to look at the issues I’ve been having with my left leg since the accident. I therefore decided to book the operation with Prof. Wilson and Dr Khakha for the 12 October 2108.

I was expecting the recovery to be extremely painful as per my big previous knee operation. I was also hoping that both my knees would be significantly improved and I’d be able to play with my son, go for walks and cycle a lot better again.

It’s less than 2 weeks since the operation but I’ve been really impressed by care by everyone. The anaesthetist even came to see me a couple of days after my operation and carefully went through all the drugs I was taking home with me. Though hardly a walk in the park I’ve been in a lot less pain than I thought I would be. I can already use my right leg a bit and it’s definitely a lot straighter and isn’t trying to collapse inwards any more. My left knee is also better as apparently I’d torn a cartilage which they’ve fixed. I can’t be certain how good it’s going to be but I’m really positive that I should hopefully be able to get back to my old activities.

Personally I really don’t like the idea of operations let alone actually having one. However I’ve been extremely impressed with the people involved who all seem to really know their stuff and have my best interests at heart. I’m really glad that I decided down this track and would very much advise anyone experiencing knee difficulties that are impacting on their life to do the same if possible.



Adrian Wilson

Adrian Wilson

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