Single Osteotomy


It may be sufficient to correct deformity by either a tibial or a femoral osteotomy alone. A knee with slight varus and little or no flexion deformity responds to a tibial osteotomy, whereas the valgus knee does not (Coventry 1975; Harding 1976). For the varus knee a dome or Brackett osteotomy (Fig. 16.11; Brackett 1912) is suitable and if adequate correction cannot be attained then either the fibula is osteotomised or its head excised.
For both the varus and the valgus knee, the results of double osteotomy are very satisfactory.


Knee Double Osteotomy

Correction of severe valgus deformity by single tibial osteotomy unduly deforms the proximal tibia and so, runs the risk of lateral popliteal nerve damage and fibular problems. Severe degrees of deformity can be corrected by double osteotomy more satisfactorily than by single. Volkmann in 1874 made this observation in correcting gross deformity after tuberculosis of the knee. Furthermore double osteotomy allows the joint-line to remain horizontal. (Babis et. al. 2002).
An opening wedge tibial osteotomy with Pudhu or other metal-work fixation is unnecessary and later may interfere with prosthetic replacement or tunnelling for ligament reconstruction.

Patellofemoral Joint

Pain relief in PFJ arthritis may be achieved not only by the 'osteotomy effect' but also by correction of fixed flexion which allows back-locking and relieves patellar overloading. Patellar tracking is improved by the valgus or varus correction.