It is well known that tibial osteotomy of arthritic painful genu varum in patients younger than 70 years of age has advantages both for the mechanical effect of symmetrical distribution of joint loading and for the biological effect produced by the bone section on the local venous intraosseus pressure which reduces pain. Patients were selected according to pre-operative X-ray evaluation of the limbs taken with the patient bearing weight on one foot: varus deformity not greater than 25°, knee flexion not greater than 15°, joint movement not less than 90° and absence of femorotibial subluxation or other instabilities. Surgery consists in application of three proximal and two distal screws into the medial side of the tibia. An Orthofix Fixator with self-aligning body is applied and an oblique osteotomy performed medially through a 3-cm skin incision using a drill bit and an osteotome to keep the lateral cortex intact in order to avoid lateral translation of the distal segment.

The patient can correct progressively the deformity himself by distracting the compression-dsistraction unit with an allen wrench. Once the desired correction has been achieved (8°–10°), a control X-ray is taken and the central body locking nut of the fixator tightened. Patients can bear full weight with crutches 4–5 days after surgery.

We have treated a total of 163 patients (92 men, 71 women). Their average age was 60 yearsand average healing time 75 days. Results were excellent in 60%, good in 25%, fair in 10% and poor in 5%. The average post-operative valgus was 9%. The technique and the clinical results are discussed.