Indications
When it may preserve the joint
an active patient in whom joint replacement may be deferred, provided cartilage and movement remain suitable.
- predominantly medial pain in a varus knee with a preserved lateral compartment
- predominantly lateral pain in a valgus knee with a preserved medial compartment
- malalignment that would overload ligament reconstruction, meniscal root repair or a cartilage procedure
Types
HTO, DFO and double-level correction
High tibial osteotomy (HTO) is commonly used for tibial varus. Distal femoral osteotomy (DFO) addresses femoral deformity, often valgus with lateral compartment overload.
When deformity arises from both tibia and femur, a double-level osteotomy may avoid creating abnormal joint-line obliquity. Opening- versus closing-wedge technique depends on anatomy and the correction goal.
Planning
Correction belongs at the site of deformity
A standing long-leg alignment radiograph is essential. Mechanical axis, femoral and tibial angles, joint-line orientation and the contribution of intra-articular laxity are assessed.
MRI may add information about meniscus and cartilage, and CT may be required for rotational deformity. The goal is a physiological correction rather than automatic overcorrection.
Combined procedures
Meniscus, cartilage and ligaments
In selected cases, osteotomy can be combined with meniscal root repair, ACL/PCL reconstruction or cartilage surgery. Correcting alignment reduces forces that might otherwise overload the reconstruction.
The order and combination of procedures depend on the dominant problem, stiffness, stability and biological healing requirements.
Limits and risks
It is not appropriate for every arthritic knee
Advanced diffuse osteoarthritis, severe loss of movement, mainly intra-articular deformity or inability to follow rehabilitation may favour another treatment.
Risks include delayed union, nonunion, hinge fracture, infection, venous thromboembolism, implant irritation and under- or overcorrection. Smoking cessation is important for bone healing.
Rehabilitation
Bone healing governs progression
Movement and muscle activation begin early, but weight bearing depends on the osteotomy, fixation and associated procedures. Loading is advanced after clinical and radiographic review.
Running and pivoting sport resume only after union and recovery of movement, strength and functional control.