Abstract
Osteotomy is an alternative treatment for unicompartmental disease (UCJD) of the knee with or without patellofemoral disease. Untreated, UCJD does progress. The ideal patient is young, with progressive early disease, high activity and a high pain threshold. Preoperative planning is essential and should include arthroscopy.
In genu varum, the aim is to transfer the weight-bearing axis from the medial to the lateral compartment. This is best achieved by a high valgus closing wedge, which corrects close to the deformity and has a high union rate. At 5–7 years, good or excellent results vary from 75–85%. Better results are achieved with a low adduction moment, metaphyseal bowing, early disease, low body weight in younger patients; over correction to 5° is important.
Complications and poor outcomes have been reported, but recent long-term follow-ups show that an incomplete osteotomy with precise jigging, compression fixation, early mobilisation, and weight-bearing eliminates many of these problems. Recent studies have shown that the outcome of post-osteotomy TKA is no worse than primary TKA that patella baja is related to postoperative immobilisation and that uni’s are more difficult to revise because of bone loss.
Supracondylar osteotomy is preferred to HTO for genu valgum. Correction should be to beyond 6° of mechanical varus. A lateral opening wedge using a toothed plate is preferred, as it allows easy access to the lateral compartment through the same incision and is more precise.
Osteotomy, far from being obsolete, has an increasing role in joint resurfacing procedures, is less of a gamble, and certainly deserves a “seat at the table”. It may be combined with other reconstructive procedures.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
