1. Upper Tibia Osteotomy Single incision & MIS H.Makhmalbaf MD Consultant Orthopaedic & Knee Surgeon Mashad University

2. History: Coventry 1965 Long incision Exposure of the proneal nerve Osteotomy of the head of Fibula Reattachment of the conjoined tendons Closed wedge osteotomy of tibia Fixation with stepped staples & POP

3. Other techniques Dome shaped osteotomy (fibular shaft) Gradual correction with open wedge & Ex-fix Open wedge & plate fixation Closed wedge & plate fixation + or - POP Pitfalls of each technique

4. Complications of UTO Undercorrection or overcorection Loss of correction Delayed union or non-union Nerve injury, vascular injury Compartment syndrome Implant failure

5. Complication of UTO Penetration of the knee joint by implants Tibia & fibula fracture Fibula non-union Fracture of the proximal fragment of tibia DVT& PE Infection Jeoperdy of future surgeries

6. What is best: Less invasive & minimal incision Avoid proneal nerve No fibular shaft osteotomy Single incision away from future TKR incision No metalwork,less exposure, less infection No second operation for removal of implant Less expensive

7. Pitfalls: POP for 6 weeks Limitation of ROM of the knee LCL laxity? Higher rate of VTE?

8. Previous study results: 1382 21 patients,22 knees, 8 male, 13 female Age; 16-65, cc: was pain + deformity Med compt. OA in 11, PFJ involvement in 4 No OA in 6

9. Results : Excellent in 3 Good in 11, Fair in 6, Poor in 1 Better results in men Better results in under 60 & 40y BMI affects the results directly Indexes: Pain, loss of correction, opening of medial joint space, no deterioration of OA

10. Complications: Loss of correction, 6 deg in 14 pts. Paresthesia in foot 6 pt No non-union Superficial infection in 1

11. UTO scar

12. Previous UTO

13. Modified technique

14. Surgical incision

15. Exposing tibia

16. Patella tendon lifted up

17. Fibula osteotomy

18. Tibia osteotomy:

20. Completion of osteotomy

21. Wedge removal

22. Wedge outside osteotomy

23. Fixation with staples

25. Placing the staples

26. Before closure

27. After closure

28. POP applied

29. Pre & Post op:

30. Bilateral 2 stage UTO

31. R leg modified Coventry

32. Walking shoe

33. Thank you