Proximal tibial osteotomy: where did you go?

The prevalence of knee osteotomy seems to have diminished. Better total knee arthroplasty (TKA) results, greater survival, increased use of unicompartmental arthroplasty, and decreased surgeon confidence for osteotomy are likely causes. However, continued use of knee osteotomy is encouraged by this author. TKAs are not perfect. Furthermore, there is limited long-term durability data for younger, active patients. At 40 to 60 years of age at the time of surgery, some patients will need prosthetic replacements that must last up to 40 to 60 years. A case is made for performing an osteotomy earlier rather than later. Regarding TKA after proximal tibial osteotomy, the difficulty and inappropriateness of the standard comparisons are clear. Comparison of a virgin primary knee at one point in time, with a patient whose situation led to osteotomy surgery 5 to >10 years earlier is not a matched comparison. It is proposed that future biologic resurfacing, together with computer-and even robotic-methods, as well as other advances in biology and technology, will combine to resurrect the performance of knee osteotomies.