Important points regarding high tibial osteotomy for asymptomatic bowleg correction in younger patients

Osteotomies are generally performed for osteoarthritis and osteonecrosis. The corrective osteotomy technique is adapted to correct lower limb deformities caused by trauma, infections and congenital diseases such as Blount’s disease, rickets and skeletal dysplasia. Previous literature has discussed the surgical procedure, period and technique of osteotomies to correct these deformities.1, 2, 3 As we mainly treat knee-joint deformities at our hospital, we occasionally encounter younger patients who wish to undergo cosmetic corrective surgical treatment for bowlegs. They have no pain or functional disorder in their knees, and therefore could live an ordinary life without surgical treatment. However, most cannot live an active social life because of mental trauma and psychiatric disorders. From the patient’s appearance, it is impossible to notice these factors and understand their true suffering. Generally, cosmetic corrective surgery is not performed for asymptomatic bowlegs. Doctors hesitate to perform cosmetic operations, as post-operative complications and patient satisfaction cannot be guaranteed. However, we chose to perform cosmetic high tibial osteotomy (HTO) in specific cases. Personality disorders, especially in younger patients, are associated with poor cosmetic surgery outcomes.4, 5, 6, 7, 8 However, by supporting the patient’s physical and mental condition before the operation, we obtained good clinical results both physically and mentally. HTO is a useful tool for physical conditions that include mental factors. Given the availability of cosmetic knee osteotomy techniques to correct lower limb deformities in younger patients, we report on surgical planning and several important technical points.