Upper tibial osteotomy.

ABSTRACT

Arthritis of the knee usually produces a change in the coronal plane of the normal femorotibial axial alignment. This change occurs if the arthritis is mostly unicompartmental. Most unicompartmental degenerative arthritis involves the medial compartment, producing a varus deformity. In rheumatoid patients, however, a valgus deformity is commonly produced. For at least the last 25 years, upper tibial osteotomy has been used to correct this malalignment. The rationale is to unload the more involved compartment and transfer the load to the less involved side. While the vast majority of upper tibial osteotomies are done for degenerative arthritis, the procedure is occasionally indicated in the inactive stage of rheumatoid arthritis. A study of 213 knees with a 16-year follow-up period showed that, even before total knee arthroplasty (TKA) was available as an alternative, 61% of the knees were satisfactory after ten years. With the additional choice of either unicompartmental or bicompartmental TKA during the past decade, the selection for upper tibial osteotomy can be more specific. The need to overcorrect to about 10 degrees of valgus in a varus knee has been established. In addition, technical aspects have been improved. With the more specific selection of patients and improvement in the exactness of the technique, an even higher incidence of long-term excellent and good results can be anticipated. Finally, it has been clearly demonstrated that when the bone and articular cartilage are relieved from the overloaded state, the cartilage will regenerate. Thus, upper tibial osteotomy not only relieves pain and improves function but also allows for healing of the articular cartilage.