Thomas Youm,MD,FRCS
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High Tibial Osteotomy using the iBalance system

High Tibial Osteotomy (HTO) is a joint preserving procedure aimed to limit the degeneration of the knee joint by correcting the alignment of the leg. Significant deformities of the knee such as “bow-leggedness” or “knock-knees” can lead to early degeneration of the knee joint, which at some point can lead to arthritis and total knee replacement. HTO not only improves the cosmetic deformity of the knee, but also allows the patient to have a high-functioning knee. A patient who undergoes HTO can delay or even avoid a total knee replacement. Because an HTO is not a knee replacement, there are no restrictions as far as sports or activities after the procedure.

Traditionally, a HTO was performed using a metal plate and metal screws to fix the bony correction. Disadvantages of the metal plate and screws included hardware-related complications such as pain and prominence. The metal would also make it difficult to diagnose any future injuries to the knee because an MRI would be significantly limited due to artifact from the metal.

The iBalance system consists of a nonabsorbable PEEK (plastic) implant and anchors. PEEK is more biologically friendly to the bone than metal and also potentially avoids the need for further surgery to remove prominent, painful hardware that was associated with the traditional metal plate and screws. The system also includes an instrument set highly specific to the implants that create a safety “envelope” with unique retractors. This ensures that the surgeon cuts the bone safely and accurately, significantly reducing the chance of neurovascular injury or an iatrogenic fracture.

Figure 1. A picture of a HTO using the iBalance implant and screws

A picture of a HTO using the iBalance implant and screws

Figure 2. Pre-operative x-rays of bilateral varus (bow-legged) knees

Pre-operative x-rays of bilateral varus (bow-legged) knees

Figure 3. Post-operative AP X-ray of the knee after HTO with the iBalance system.

Post-operative AP X-ray of the knee after HTO with the iBalance system.

Figure 4. Post-operative Lateral X-ray of the knee after HTO with the iBalance system.

Post-operative Lateral X-ray of the knee after HTO with the iBalance system.

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