Osteotomies Still Effective in Treating Arthritis

Osteotomies may be falling out of favor with some orthopaedists, but they still can be effective for young, active patients with medial compartmental knee arthritis and constitutional malalignment, according to an expert in the field.

“I think HTO (high tibial osteotomy), as of today, is a valuable tool in treating medial compartment arthritis in active patients. It is important to assess the level and the degree of deformity. It is not always on the tibia—and to correct on the right level. Finally, patient-specific guides can offer great advantages for biplanar correction,” Jan Victor, M.D., Ph.D., said at the Current Concepts in Joint Replacement Winter Meeting in Orlando, Fla.

Currently, orthopedists prefer to perform arthroplasties on young, active patients with significant deformities despite evidence that shows disappointing results for knee arthroplasty in these patients. Osteotomy, however, can be a more logical procedure for these patients, according to Victor, a professor of orthopedics and chair of the Department of Orthopedics and Traumatology at Ghent University in Belgium.

Osteotomies can make it difficult to achieve a predictable degree of correction, he noted, but new technologies being developed should make them easier to perform and improve their accuracy, Victor said.

While most orthopaedists rely on 2-D radiographs for osteotomies, Victor said magnetic resonance imaging and computed tomography scans can offer better outcomes.

Victor and colleagues studied using image-based navigation and patient-specific cutting blocks for osteotomies around the knee in 14 patients.

“The first 14 patients showed very good results and encouraging results on accuracy,” he said. “We evaluated the alignment to the coronal and intersectional plane. The correction is then virtually performed and a guide is designed in order to have the correct level and correct amount of correction for these patients.”

Victor noted that this technique can bring the osteotomy and fixation within 2 degrees of accuracy.