High tibial osteotomy--an effective treatment option for osteo-arthritis

Most patients of symptomatic osteo-arthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment osteo-arthrosis of the knee. Between 2007 and 2012 we performed closing wedge osteotomy in 44 knees in 42 patients. Of the 10 patients who had bilateral symptomatic disease, 2 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Pre-operative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA) rating scale. At a minimum follow-up of 6 months (range 0.6-5 years) 6-10 degrees of valgus correction at the site of osteotomy was maintained. The visual analogue scale (VAS) score improved from mean of 5.77 to 1.5. Approximately 19 satisfied with this operation. The JOA score mean 55 (range 45-61) improved to 86.18 (range 82 to 89). The activity of daily living (ADL) like rising from chair, going upstair and downstair, improved in all patients. Walking distance improved in all patients. No patient was lost any pre-operative knee function. Closing wedge high tibial osteotomy performed by our technique can be undertaken in any set-up with moderate facilities. Operation related complications are minimal and avoidable. Closed wedge osteotomy is least likely to interfere with replacement surgery if it becomes necessary.