Modified HTO : MHTO BY DR.SOMSAK
“The Latest and Most Innovative Operation Techniques for Bowlegs”
Advantages of Modified HTO with New Charnley Clamp:
- Small cut wound around 1.5 to 2 centimeters; less time spent on the operation.
- Minimal blood loss; no need to use the tube to drain out the blood from the wound.
- Less pain; short time spent in the hospital (only 2 to 4 days).
- The operating tools are newly designed to be of smaller size and not to be left permanently in the bone.
Modified HTO with New Charnley Clamp
The method is the same as HTO, the third method, in using the Titanium Pedicular screw external fixator. The modification made the operation procedure faster, and with the patient having a smaller cut wound.
The two former heads of The Bone and Joint Department at Chulalongkorn Hospital were the initiators of the method.
The first one, Dr. WinaiPakpian started the method with the tools he himself brought back from the UK. Another one is Dr. PrakitTianbune. He developed many new operation tools and techniques, which gave a good chance for orthopedic doctors in Thailand to use better tools. The writer had a chance to top on the tools and technique development for the following methods:
1. The external titanium pediculate screw fixator size is smaller and requires only two (2) pins to pierce through the bone
2. The smaller operation tools give smaller cut wound.
The wound size is 1 to 2 cm in the front and 0.5 cm on the side of the lower leg.
3. The new method is a Minimal Invasive Technique.
The patient bleeds less so there is no need for an insertion of a tube to drain out the blood from the wound during the operation. In the old technique, the tube will be left in the wound for two days, and the patient will feel the pain again when the tube is removed.
Six to eight (6-8) weeks after the operation, the legs will be straightened, and instrumentation is taken out. Removal of the fixator can be done in the outpatient room without additional surgery to open skin wounds again, and there is no need to use the local or general anesthetics. The patient will feel only a small degree of darting pain.
This method uses the surface cartilage that is left to help take in the body weight load. The joint surface at the outer side remains functional and in good condition, and there is no need for it to be totally removed, compared to the operation of putting in an artificial joint.
For a patient to have a life-long use of the operated knee, Active Muscle Training Exercise is the best and most effective method of exercise for the front thigh muscle.
The operated knee that has been taken good care of has a rare chance of recurring pain and problem. International researches found that after 10 years of use, 89% of patients still have good knee conditions and functions without pain involved.
In addition, one must remember to be extra careful and responsible after the surgery. If the operated patient achieved straight legs without recurring pain but the patient does not do the thigh muscle training exercise or neglects to watch out for other risk factors such as being overweight, putting lots of workload on the knee, neglecting food that nourishes the joints, then the long-term use of the knee will be shorter.
|The comparison of Modified HTO with New Charnley Clamp and Total Knee Replacement|
|Modified HTO with new Charnley clamp||Total Knee Replacement|
|Scar size||2 positions of 1-2 and 1 position of 0.5 centimeter||1 point of 8-15 centimeters|
|Right age||No limitation; if the joint surface is not over 50% ruined||The older, the better|
|If both legs are severely bowed starting at young age,|
the operation should be done at the same time
|More than 55 years old|
|Knee-joint condition||Knee joint/bow leg: intact, little damaged, moderate damaged||The last stage of the deteriorated knee joint|
|Operation||Cut outside the joint at the base of the bone||Cut into the joint|
|No cutting off the joint surface||Cutting off the joint surface|
|No loss of bone mass||Loss of bone mass|
|Duration of operation||30-45 minutes||60-120 minutes|
|Usage||No limitation; can be according to age range||Cannot play heavy sports|
|Active, Sports Player||Low Demands|
|Limited pain and inflammation||Limited pain and inflammation|
|Recovery of Cartilage||Can be recovered if the cartilage is not totally damaged||None because the cartilage had been taken out|
|Instrumentation in the bone||None, all will be taken out||Stuck within the knee joint for a lifetime|
Example of the patients that have the operation to correct bowlegs, using MHTO techniques on the two legs at the same time.
Note : Actual photos (Credit to our patients)
Dr.Somsak Laowattana, M.D.
Bangkok Advanced Clinics
1/18 Soi Sukhumvit 24
Bangkok – Thailand
Tel : +66 (0)2 000 3535 (Thai)
+66 (0)99 216 0216 (Thai)
+66 (0)81 632 6138 (English)