Tibial Osteotomies: No Perfect Road, All Detours Have Their Own Potholes.

Abstract

When it comes to surgical interventions for varus malalignment and medial compartment osteoarthritis, proximal tibial osteotomy (PTO) continues to be a cornerstone procedure-offering biomechanical correction, symptom relief, and a welcome detour from the highway to total knee arthroplasty. But as with all detours, the path is not without its own potholes: loss of correction, patella baja, and increased posterior tibial slope (PTS) remain persistent issues, particularly with the traditional medial opening wedge technique. Attempts to avoid these complications can be done by taking special considerations into the type of osteotomy (medial opening wedge vs. lateral closing wedge), fixation modality, the size of the opening wedge (or closing wedge), location and angles of the osteotomy cuts, and the use of allograft or autograft to fill in osteotomy site. However, each new technique that is presented comes with its own unique set of complications making a recommendation of one technique for all patients nearly impossible. Further inquiry into a one-size fits all technique may be futile and the future may lie in patient-specific osteotomy techniques.