**6.2 Osteotomies**

Osteotomies are performed to restore a more anatomic biomechanical environment and prevent or delay the onset of OA or slow its progression.

In symptomatic patients with OA, osteotomy is performed to realign joints with the aims of relieving pain and delaying the onset or progression of OA. Osteotomy and joint preserving surgical procedures should be considered in young adults with symptomatic OA, especially in the presence of dysplasia or varus/valgus deformity.

### **6.2.1 Indications**


### **6.2.2 Contraindications to osteotomy**


### **6.2.3 Surgical types and methods**

216 Biomedical Science, Engineering and Technology

Despite huge laboratory and clinical research, there are no proven diseases modifying therapies for OA. However, emerging orthopaedic surgical procedures may help to alleviate

Arthroscopic surgery is a routine surgical procedure for joint debridement and lavage in the management of OA since the 1980s. The advent of this technique has permitted less invasive access to joints and the opportunity to intervene earlier in the course of joint destruction, potentially to delay and/or prevent a predictably progressive degenerative pathway. However, in recent times the only indication where this technique is thought to be of benefit is in the management of OA with a superimposed structural lesion such as a meniscal tear in

There is a strong research and clinical evidence that patients with symptoms attributable to knee OA per se, and not meniscal tear, do not improve following arthroscopic lavage and debridement. Whether APM is useful in patients with symptomatic meniscal tear and concomitant OA is unclear at this stage. This is an area of investigation at the moment.

Osteotomies are performed to restore a more anatomic biomechanical environment and

In symptomatic patients with OA, osteotomy is performed to realign joints with the aims of relieving pain and delaying the onset or progression of OA. Osteotomy and joint preserving surgical procedures should be considered in young adults with symptomatic OA, especially

• As an adjunct in younger patients with predominantly unicompartmental OA

• 10 to 15 degrees of varus deformity on weight bearing radiographs

• Ability and motivation to effectively and safely perform rehabilitation

the attendant pain and functional loss resulting from joint damage in OA. Some of the surgical approaches in the management of OA include

which arthroscopic partial meniscectomy (APM) is performed simultaneously.

• Arthroscopic approach

• Total joint replacements and arthrodesis • Tissue engineering and biologic therapies

• Meniscal Transplantation (MT)

**6.1 Arthroscopic procedures for OA** 

• Autologous Chondrocyte Implantation (ACI)

prevent or delay the onset of OA or slow its progression.

in the presence of dysplasia or varus/valgus deformity.

• Preoperative motion arc of at least 90 degrees • Flexion contracture less than 15 degrees

• Lateral tibial subluxation greater than 1 centimeter • Medial bone loss greater than 2 to 3 millimeters

**6.2.2 Contraindications to osteotomy**  • Lateral compartment loss of joint space

• Osteotomies

**6.2 Osteotomies** 

**6.2.1 Indications** 

• Age less than 60 years

• Ligamentous instability • Inflammatory arthritis


Fig. 4. AP radiograph of medial opening wedge high tibial osteotomy performed for medial compartment osteoarthritis.
