Osteotomy or Joint Replacement ?


The risk of mechanical prosthetic failure in a young active person is higher than in the elderly. The long postoperative recovery period required after osteotomy at a weight-bearing joint generally contraindicates this operation in the elderly. The serious complications of total replacement and the lesser complications of osteotomy should be discussed with the patient and his/her family before surgery. Prosthetic replacement is undesirable in the presence of chronic varicose ulceration and osteotomy might be indicated in such circumstances where it would not otherwise be considered.. Previous osteotomy does not prejudice subsequent prosthetic replacement (Amendola et al. 1989). At the knee, correction of deformity by osteotomy and the increased bone density following osteotomy leave more satisfactory bone stock for subsequent prosthetic replacement.
Osteotomy is preferable in the young sportsman with degenerative changes following a tibial plateau fracture or other knee injury.
In some areas of the world, replacement prostheses and instrumentation are unavailable and theatre conditions may not be suitable.
A good osteotomy is better than a good total knee, it will wear better, better fall back (Cross M 2005)

When osteotomy is a reasonable alternative is it justifiable to replace a joint?