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Osteotomy provides satisfactory results in treating knee arthritis in younger patients
Though the typical osteotomy patient is now younger, the procedure is still effective.
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Osteotomy is a useful, effective procedure and still has a role in the treatment of young, active patients, according to the experience of Robert T. Trousdale, MD, as presented at Orthopedics Today Hawaii 2009.
Trousdale covered the use of the osteotomy procedure (opening and closing wedges), claiming results are predictable and reasonably durable.
Changes in osteotomy use
“Osteotomy’s role has changed dramatically,” Trousdale said. “We are doing a lot less of these now than we did 20 to 25 years ago. Having said that, there is a subset of patients in whom this is the best operation.”
The typical osteotomy patient is now younger than we saw 15 or 20 years ago, Trousdale said, with a mean age – in his experience – of 38 years. Intervention occurs earlier now, and utilizes smaller angular corrections that demand precision.
The two major pitfalls in performing osteotomy primarily involve poor patient selection and faulty technique resulting in poor alignment, Trousdale pointed out.
Closing wedge pros/cons
There are a number of different techniques available for the performance of the osteotomy, including closing wedges, opening wedges, and working above, behind and below the tibial tubercle. Fixation options include casts, plates, staples or external fixation.
Lateral closing-wedge osteotomies involve osteoclasis of the medial tibial cortex and leaving an intact periosteal hinge, as well as offering the advantage of excellent opposition of cancellous bone. The downside is that it shortens the leg, increases ACL laxity, changes the Q-angle and also the tibial plateau position in relation to the tibial shaft, he said.
Opening wedges make it technically easier to obtain precise correction, thanks to incremental adjustment. The primary work is done away from the peroneal nerve and tibia/fibular joints, and two-plane osteotomies are made relatively easy during an opening wedge procedure.
Downsides include the need for bone grafts and a slower progression to union than that found in closing wedges, especially in large corrections.
He said postoperative care involves toe-touch weight-bearing for a span of 6 to 8 weeks. A protective brace may be utilized, if only for comfort, and the knee may be moved as far as the patient can tolerate immediately.
For more information:Reference:
- Robert T. Trousdale, MD, is a professor of orthopedics at the Mayo Clinic in Rochester, Minnesota, and can be reached at the Mayo Clinic Department Of Orthopedics, 200 1st St SW, Rochester, MN 55905; 507-284-3663; e-mail: trousdale.robert@mayo.edu. He has no direct financial interest in any products or companies mentioned in this article.
- Trousdale, RT. Nonarthoplasty options for knee arthritis. Presented at Orthopedics Today Hawaii 2009. Jan. 11-13, 2009. Kohala Coast, Hawaii.