Tibial Condylar Valgus Osteotomy Combined With Inverted V‐Shaped High Tibial Osteotomy

In constructing surgical strategies for correction of varus deformity in osteoarthritic knees, both bony and intra‐articular deformities should be taken into consideration. Bony deformity is corrected by high tibial osteotomy (HTO), whereas intra‐articular deformity associated with increased joint line convergence angle can be addressed by tibial condylar valgus osteotomy (TCVO). In the TCVO procedure, the medial tibial joint line is elevated by an L‐shaped osteotomy. A surgical procedure combining open‐wedge HTO and TCVO has been reported before. Although this combined procedure can address both bony and articular deformities, correction of severe bony deformity by open‐wedge HTO with large wedge opening may induce problems of unacceptable joint line obliquity and increase in leg length. In this situation, inverted V‐shaped HTO reported by Aoki and Kondo can be an alternative option. The inverted V‐shaped HTO procedure is designed to combine hemiclosed and hemiopen osteotomies. However, the correction is made near the center of rotation of tibial angulation, and wedge width can be reduced compared with other HTO procedures; potential problems associated with conventional HTO can be avoided. In this paper, the surgical rationale and sequence of combined TCVO and inverted V‐shaped HTO for correction of severe varus deformity are described.