High tibial osteotomies: indications and techniques

The rationale, definition, and techniques of high tibial osteotomies are discussed. The principle indication includes unicompartmental medial or varus knee gonarthrosis with a well-maintained range of motion. Preservation of bone stock and intraarticular structures and realignment during chondral resurfacing procedures are the major advantages of high tibial osteotomies. Newer techniques have provided for less invasive surgical methods, more rigid fixation, accelerated rehabilitation, and improved accuracy of correction for high tibial osteotomies. However, permanent pain relief with high tibial osteotomies is unlikely; overall survival approximates 8 to 10 years. Subsequent conversion to a total knee arthroplasty may at times be technically demanding but the long-term results are likely to be similar to a primary total knee replacement.