(ii) Osteotomy for osteoarthritis of the knee

Osteotomy is a classic operation in the treatment of uni-compartimental osteoarthrosis of the knee. In the modern context it is used to correct initial varus, or valgus, deformity before slight chondral damages advance to become progressive irreversible articular disease. It has been presented as an alternative to prosthetic joint replacement, but the indications depend on the stage and articular spread of degenerative changes and on the patient's general state. Indications for surgery are very different, in most of the cases, from the indications for uni or total knee replacement. Since the early nineties we have practiced a modern and relatively new technique in performing knee osteotomies based on a special dedicated system of instruments and plates. This opening wedge technique, when compared to Coventry's antivarus closing wedge osteotomy, inverts the method of correction, adding the wedge medially instead of removing it laterally; in case of valgus deformity osteotomy is carried out on the femoral side with a lateral opening wedge. Operative techniques of high tibial osteotomy and osteotomy of the distal femur will be illustrated with particular attention to all details of the two operations in 'step by step' descriptions. (C) 2005 Published by Elsevier Ltd.