Opening wedge osteotomy offers precise correction but longer time to union

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January 16, 2008

LAHAINA, Hawaii - While the use of nonarthroplasty options for knee arthritis has diminished during the last decade, one orthopedic surgeon presenting here said that realignment osteotomy remains a good option for a certain patient population.

Today, patients undergoing realignment osteotomy, which can result in the transfer of weight-bearing forces from the arthritic portion of the knee to a healthier location in the joint to increase its lifespan, tend to be younger and more active than in years past, Robert T. Trousdale, MD, said at the Orthopedics Today Hawaii 2008 meeting.

"Over the past 5 years in our clinic, the average patient age [for osteotomies] has been 38 years old, and there has been a trend toward smaller annular corrections, too," said Trousdale, an orthopedic surgeon at the Mayo Clinic in Rochester, Minn. Also, orthopedic surgeons today "are tending to perform osteotomies in combination with other procedures, including ACL or PCL reconstructions and articular cartilage and medical allograft transplants," he said.

Two major pitfalls for osteotomies are poor patient selection and technique, which often results in poor alignment postoperatively, he said.

Trousdale said he prefers to use the opening wedge osteotomy rather than the closing wedge approach.

"Some of the advantages of the medial opening wedge osteotomy include a more precise correction, its ease of use, it avoids the proximal tibiofibular joint, and it does not require a fibular osteotomy. It also restores tension to a lax medial cruciate ligament," he said.

However, "The cost [of an opening wedge osteotomy] is that it takes a longer time to [achieve] union. The other downside is that a handful of these patients can have symptoms along the medial side of the knee. In these patients, we may have to take these plates off a year or two after surgery," he said.

For more information:

Trousdale RT. Nonarthroplasty options for knee arthritis. Presented at Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.