Varus tibial osteotomy

Varus tibial osteotomy for early lateral compartment osteoarthritis is controversial because of the induced obliquity of the joint line. Many practitioners favor a femoral osteotomy, but both procedures can be criticized. A varus femoral osteotomy is efficient in extension, but at 90 degrees of flexion it is inefficient, and we can observe an internal rotation of the epiphysis compared with the diaphysis. The tibial osteotomy is efficient both in flexion and extension but creates an oblique joint Line. Ln our experience, we found that a varus tibial osteotomy can give good results in patients younger than age 60 with stable knees having an early lateral compartment localized at the peripheral rim in the meniscal area. The goal is to create a normal axis with no more than a 10 degrees obliquity of the joint Line. This value must be calculated preoperatively with regard to both femoral and tibial mechanical axis. The purpose of this report is to discuss the indications of a varus tibial osteotomy based on mechanical analysis and clinical experience. This type of intervention is oriented toward mild lateral compartment osteoarthritis. For the purpose of this report we have excluded both intraarticular and extraarticular malunion which are responsible for other specific problems.