Osteotomies Around the Knee - a Narrative Review of the Current Standard

Knee osteotomies have been established for more than a century as an effective treatment for degenerative and post-traumatic deformities of the lower limb. The aim of this narrative review is to present the current state of knee osteotomies and to outline the relevance of correction in the coronal, sagittal, and axial planes, as based on current evidence and clinical examples.Technical advances, such as digital preoperative planning, biplanar osteotomy techniques, and modern locking plate fixation have significantly reduced complication rates and improved overall clinical outcomes. Open-wedge high tibial osteotomy remains the standard procedure for tibial-based varus deformities and yields excellent results when appropriately indicated. For femoral-based varus or valgus malalignment, biplanar distal femoral osteotomy has become the preferred technique. The use of a hinge wire led to a reduced risk of intraoperative hinge fractures. Double osteotomies are particularly useful in combined deformities of the femur and tibia, and allow preservation of the orientation of the physiological joint line. Several studies have reported excellent functional outcomes with this approach. Corrections in the sagittal and axial planes are gaining increasing importance, especially in cases of patellofemoral pathology, increased tibial slope, or post-traumatic rotational deformities. Overall, knee osteotomies are a reliable and effective method for managing complex deformities. When properly indicated, they can delay or even avoid the need for knee arthroplasty, offering a durable joint-preserving treatment option.