Aim: The purpose of this study is to establish if there is any or no beneþt in performing an opening wedge tibial osteotomy (TO) in patients normally requiering a total knee replacement (TKR). Methods: A group of 70 patients having been initially diagnosed with a form of osteoarthritis of the knee that would normally coun-terindicate an osteotomy (age over 65, stages, Ahlback III or IV, presence of patello-femoral arthritis) but in which other factors (associated pathology, age under 40, hard physical labour) did not allow as to perform a total replacement of the joint and who þnally underwent a T.O. (using an acrylic cement spacer) was followed-up for a mean period of 6.5 year both clinically (using 2 functional scores) and radiologically.

In all patients weight-bearing AP radiographs taken preoperatively showed a degree of varus malalignement. Results: Only 5 patients from the initial group required a TKR during the follow-up period. In most cases results were good regarding painless motion and activity and satisfactory regarding the amplitude of movement, even in cases with no radiological improvements. Conclusion: We consider that opening wedge osteotomy may still represent a valuable solution in treating severe cases of osteoarthritis of the knee in which T.K.R. is not possible due to various reasons, also bearing in mind that is far more easy to perform a TKR after an opening wedge osteotomy than after a closing wedge technique.