High tibial osteotomy for the treatment of unicompartmental arthritis of the knee

High tibial osteotomy has to be considered a valuable option in the surgical management of knee osteoarthritis. Localized wear in the knee corresponds to a malalignment that is either causative of or contributory to the arthritis. For many years, the value of osteotomy to correct malalignment has followed the principle of transferring load to the unaffected compartment of the knee to relieve symptoms and slow disease progression, and has been used extensively, with techniques becoming more refined over time [I]. In addition, despite good long-term results with total knee arthroplasty, there remains a significant concern regarding the longevity of these prostheses, particularly in younger patients. In contrast, osteotomy provides an alternative that preserves the knee joint and, when appropriately performed, should not compromise later arthroplasty if it becomes necessary. The reported results of high tibial osteotomy vary considerably across the literature, but the procedure generally provides good relief of pain and restoration of function in approximately 80% to 90% of patients at 5 years, and 50% to 65% at 10 years [2-7]. In the analysis of these results, most authors have found that success is directly related to achieving optimal alignment [3,6,8]. Accurate preoperative assessment and technical precision are therefore essential to achieving satisfactory outcomes. Many techniques have been described for proximal tibial osteotomies. This article discusses the various options available for alignment correction in the treatment of osteoarthritis using proximal tibial osteotomy and outlines the appropriate indications and technique.