A new approach to dome high tibial osteotomy.

This article describes a study that evaluates a combined arthroscopy and high tibial osteotomy treatment protocol incorporating: a new curved and double-bladed barrel vault (dome) osteotomy guide; measurement of the mechanical axis of the limb during surgery as well as measurement of the femorotibial angle and mechanical axis before and after surgery; and prior arthroscopic evaluation and debridement. Forty-five high tibial osteotomies were performed in 42 patients. All 45 knees had varus angular deformity. Arthroscopy confirmed osteoarthritis in all 45 knees and grade 4 medial compartment chondromalacia in 44 of 45 knees. Patients were evaluated preoperatively and postoperatively using a grading scale modified from that of the Hospital for Special Surgery. Follow-up of patients ranged from 1 to 6 years (mean: 3.1 years). The average clinical score was 57.4 preoperatively and 89.8 postoperatively, an improvement of 56.4%. All patients achieved and maintained pain relief compared with their preoperative status. No patient needed total knee replacement. These results indicate that in patients with unicompartmental osteoarthritis with angular deformity, high tibial barrel vault (dome) osteotomy can improve the quality of life while preserving the knee joint. There was no relationship between clinical score and either patient age or severity of lateral compartment chondromalacia. Therefore, osteotomy may be appropriate for a larger population than generally thought.