Abstract
Osteotomy is one of the oldest orthopaedic interventions and has evolved significantly over the years. The procedure is well established as a biomechanical solution in the treatment of arthritis and instability of the knee. The operation is technically demanding and carries risks of neurovascular injury, inadequate fixation and under- or overcorrection. These technical problems have given osteotomy significant headwind in the orthopaedic community. The relative success of knee arthroplasty (uni or total) in the past decade has fed the perception that this procedure is the only remaining treatment to be trusted for patients with knee arthritis. However, both registry data and single center studies often show disappointing results for knee arthroplasty in the young, active and demanding patient population. Osteotomy has a significant role for these patients, provided they have unicompartmental arthritis with constitutional malalignment. Also, more complex deformities as seen in the post-traumatic setting often need a biomechanical approach based upon osteotomy principles.
Recently, technology was developed to allow the surgeon perform a three-dimensional evaluation of the deformity and prediction of postoperative alignment. Patient specific guides with a broad fit on the femur or tibia can guide the osteotomy and fixation accurately, within 2 degrees of accuracy. With this technological approach, a new dawn for osteotomy appears on the horizon.
