Double Osteotomy

Osteotomy remains a useful tool in the treatment of degenerative and rheumatoid arthritis at the knee and shoulder joints. The success of total knee replacement (TKR) has over shadowed procedures aimed at the retention of bone and the re-growth of cartilage.

The reparative powers of the body are encouraged and loss of bone and joint as in TKR are avoided. At the shoulder the joint space is often seen to be increased and regeneration of cartilage appears to have occurred on arthroscopy.
Complications of double osteotomy are rare, correction of varus and/or valgus require little angulation as correction occurs not at one but at two sites.

Opening osteotomy does not require bone graft and non-union is very rare, in my experience 0.1%
Closing osteotomy does not require removal of a wedge; it is sometimes assisted in osteoarthritis by crushing of perhaps an inch of cortex. Internal fixation is not required.

Infection is very rare and when deciding between TKR and osteotomy, it is a significant feature to be considered by patient and surgeon even without the advent of MRSA

It brings pain relief and increased function for the younger patient in whom total hip or knee replacement is inadvisable and avoids the serious complications of prosthetic infection, loosening and breakage.
The Journal of Bone and Joint Surgery published the first paper on Benjamin Osteotomy in 1969.

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Alec Benjamin