Proximal tibial osteotomy for osteoarthritis of the knee with varus deformity

Objective: Correction of the axial malalignment to slow down wear tear of the medial compartment of the knee in instances of medial compartment osteoarthritis with varus deformity. Return to nearly normal weight-bearing ability of the knee. Indications: Patients up to a biologic age of 65 years with medial compartment osteoarthritis with varus malalignment. Contraindications: Morbid obesity, circulatory disturbances, gait disorders neurologic in origin, osteoarthritis of all three compartments. Surgical Technique: 1st step: oblique fibular osteotomy between proximal and middle third without internal fixation. 2nd step: anterolateral approach to the proximal tibia from distal-lateral to medial-proximal and resection of a bony wedge leaving the medial cortex intact. Internal fixation with a six-hole semitubular plate using a tensioner for compression of the fragments. Results: In 113 patients 121 valgus realignment tibial osteotomies for medial compartment osteoarthritis were performed by three surgeons. Minimal postoperative follow-up period 10 years. 86% of the osteotomies required no further treatment even after 10 years, a total knee replacement was done in only three patients between the 7th and 10th postoperative year. © Urban & Vogel München.