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Osteotomy may be best suited for younger patients

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KOLOA, Hawaii — In younger patients with unicompartmental articular cartilage pathologies, closing wedge osteotomy provides faster healing, and the ability to bear weight and return to work, according to a presenter at Orthopedics Today Hawaii 2015.

“Proximal tibial osteotomy, opening vs. closing wedge, is one of the least-performed orthopedic surgical procedures in the United States for unicompartmental articular cartilage pathology and is one of the least-taught procedures by the Academy or [Arthroscopy Association of North America], yet probably one of the most important to learn,” Jack M. Bert, MD, said.  

Alignment is crucial after articular surface surgery because the tissue is at risk, he said. Additionally, proper alignment decreases medial compartment contact pressure.

Jack M. Bert

Bert said there is some logic that closing wedge yields better correction. However, opening wedge is also easy to do even though nonunions may occur and patients have more time non-weight and partial weight bearing.

“Revision to total knee arthroplasty (TKA) does not appear to be an issue if rigid fixation techniques are used initially, and in most cases have the same results as primary TKA,” Bert said.

Recent study results have indicated there is no difference in knee outcome scores, complications or revision rates between high tibial osteotomy and unicompartmental knee arthroplasty, according to Bert. There was also no statistically significant difference in results when autologous chondrocyte implantation or microfracture were added to partial tibial osteotomy.

Bert advised not to add a marrow stimulation or an arthroscopic procedure to a partial tibial osteotomy, as clinical results do not improve.

“Unloading bone alone may be the single most important factor in the formation of articular surface cartilage without doing damage to the subchondral surface,” he said. – by Kristine Houck, MA, ELS

Reference:

Bert JM. Osteotomies: When to do it in the younger patient. Presented at: Orthopedics Today Hawaii 2015; Jan. 18-22, 2015; Koloa, Hawaii.

Disclosure: Bert is a consultant for Smith & Nephew, Exatech Medical Technology, Arthrex, Sonofi and Exscribe.