Optimal Technique in Knee Osteotomy

Preoperative planning for correcting lower limb alignment is crucial in order to define the tibial, femoral and intra-articular morphologies present. Various techniques have been advocated to plan and perform osteotomy with optimized accuracy but in cases where the femur or tibial deformity is not correctly evaluated, the resultant corrective osteotomies may result in an oblique joint line. Thus, surgeons should question if a high tibial osteotomy (HTO) is the best solution in all varus knees, and what are the complications and vascular risks associated with high tibial osteotomy. The unpredictable influence of the intra-articular deformity in preoperative planning is also discussed and this explains why in many cases, surgeons fail to achieve the desired level of correction. Accuracy between planning techniques like navigation, patient-specific instrumentation and conventional techniques is also addressed. A current overview and opinion of sagittal correction and patellar height after osteotomy are also given. Currently it is thought and accepted that the patellar height becomes lower by HTO. We discuss how this may not be the case with future studies. Finally, discussions on filling the gap after opening wedge tibial osteotomy are reviewed with benefits but also disadvantages of each technique.