Indication for Osteotomy in Arthritis

The indication for osteotomy is pain, which has failed to respond to conservative treatment. Although pain is the main indication for osteotomy, correction of deformity is important to achieve in the weight-bearing knee joint. Varus, valgus and flexion deformities should be slightly overcorrected.
At the shoulder osteotomy of the glenoid neck and the surgical neck of the humerus without displacement dramatically relieves pain in rheumatoid and degenerate disease of the shoulder In over 85% of patients this relief is associated with considerable increase in total shoulder mobility.


Knee

At the knee there is the choice of either a single tibial, a single femoral or a double osteotomy (Jackson and Waugh 1961; Huskisson and Phillips 1973; Coventry 1965; Benjamin 1969; Helal 1962, 1965; Angel et al. 1974). In degenerative arthritis with varus deformity, tibial osteotomy offers a high success rate, whereas with valgus deformity it does not (Harding 1976; Coventry 1975). Double osteotomy is equally rewarding in the presence of varus, valgus or no deformity.
When the arthritic changes are principally in the patellofemoral compartment pain is relieved by double osteotomy and patellectomy is not advised.
Following knee double osteotomy eighty per cent of patients have remained relieved of pain when assessed 2 to 7 years after operation. Fifty per cent remain pain free at 15 years and consider that 5--15 years' freedom from symptoms had made the operation well worthwhile.
Osteotomy in the young active patient allows a continuation of sporting activities, which may have to stop in the presence of a TKR. When finance is a compelling factor the high cost of a knee prosthesis may be avoided by osteotomy in appropriate cases.