Purpose: A high incidence of isolated medial compartment osteoarthritis has been reported in physiologically young, active patients. Many of these patients have isolated medial compartment osteoarthritis as a result of a varus knee deformity. This leads to abnormal distribution of weight, such that accelerated wear to the medial compartment occurs. Redistribution of weight-bearing forces in the knee via high tibial osteotomy (HTO) may relieve pain and slow disease progression; however, medial opening wedge HTO is associated with the risks of nonunion and loss of function secondary to healing in distraction. This video demonstrates revision medial opening wedge HTO.

Methods: This video discusses the case presentation of a 33-year-old man who underwent a right knee medial opening wedge HTO, which resulted in 13° of correction. The patient initially recovered well; however, radiographs obtained at a follow-up of 3 months revealed loss of correction and 9° of varus malalignment, with the mechanical axis passing medial to the medial tibial plateau. Recurrent medial joint line pain and clinical varus subsequently developed. The patient's body mass index (>35 kg/m2) may have been a major contributing factor to HTO failure. The patient underwent revision medial opening wedge HTO and iliac crest allograft implantation.

Results: Postoperative rehabilitation began with partial–weight bearing with the use of crutches and a hinged knee brace locked in extension for 4 weeks. Range of motion from 0° to 120° was initiated at 4 to 6 weeks postoperatively. At 6 to 12 weeks postoperatively, the patient progressed to phase one exercises, closed chain knee extension, and the use of a stationary bike. Advancement to full–weight bearing and subsequent return to sport occurred at 3 to 6 months postoperatively. At a follow-up of 4 months postoperatively, the patient was doing well and had no radiographic evidence of correction loss. The outcomes of HTO with the use of wedge bone allograft are good, resulting in low rates of nonunion and correction loss.

Conclusions: Loss of correction is a potential complication of medial opening wedge HTO. Left unmanaged, loss of correction may lead to accelerated osteoarthritis in the medial knee compartment. Revision HTO with the use of bone graft and plating is a good option to redistribute weight-bearing forces in the knee.