Medial Open-Wedge High Tibial Osteotomy for Double Varus Deformity and an Increased Tibial Slope

The goal of the modified medial open-wedge high tibial osteotomy is the combined correction of a double varus deformity (mechanical medial proximal tibia angle <84°, joint line convergence angle >2°) and an increased posterior tibial slope >12°. This goal can be achieved through a few modifications to the standard biplanar medial open-wedge high tibial osteotomy technique. These modifications include (1) positioning of the hinge anterolaterally and above the fibula, (2) removing a small anterior wedge, and (3) using Schanz screws to facilitate slope correction. Osteosynthesis is performed with a locking plate. Rehabilitation involves 6 weeks of partial weight-bearing and free range of motion.