# Novel Use of Inverted V-shaped High Tibial Osteotomy in Treating Valgus Knee via Double-Level Osteotomy: A Clinical Case Report

## TL;DR

A new surgical approach using inverted V-shaped osteotomy successfully corrected a severe valgus knee deformity in an older patient.

## Contribution

The novel application of inverted V-shaped high tibial osteotomy in valgus knee deformity correction is demonstrated.

## Key findings

- A 70-year-old patient with a -18° HKA angle achieved 10° femoral and 12° tibial correction using DLO.
- Postoperative radiographs showed maintained alignment and improved knee function scores after one year.
- iVHTO was safely applied in a valgus knee, expanding its potential surgical use.

## Abstract

Valgus knee deformity presents a surgical challenge when severe, especially with a hip-knee-ankle (HKA) angle exceeding 10°. While double-level osteotomy (DLO) is often used to correct complex deformities, the application of inverted V-shaped high tibial osteotomy (iVHTO) in valgus knees is rare. We present the case of a 70-year-old man with lateral compartment osteoarthritis and HKA of −18°, treated with DLO combining medial closing wedge distal femoral osteotomy and iVHTO. A correction of 10° at the femur and 12° at the tibia was achieved, with final alignment aimed at a mechanical axis of 45%. At the one-year follow-up, radiographic parameters showed maintained correction and bone union, with improved Knee Injury and Osteoarthritis Outcome Score. This case suggests that iVHTO, although typically used in varus knees, can be safely and effectively applied in valgus deformity as part of a DLO strategy.