Tibial Osteotomy for Osteoarthrosis of the Knee: A Five to Ten Year Follow-up Study

Abstract

Jackson in 1958 described tibial osteotomy as a method for relieving pain in osteoarthrosis of the knee.Wardlc (1962) indicated that the operation had been previously performed.Tibia1 osteotomy is now an accepted procedure in the treatment of osteoarthrosis of the knee, although reports of its efficacy in the long term are scarce.The predominant indication for tibial osteotomy is painful deformity, with stiffness, instability and loss of function as other symptoms.There have been numerous reports referring to the 70-80 per cent good early results, as regards pain relief, from tibial osteotomy (Jackson & Waugh 1961, Wardle 1962, Coventry 1965, Harris & Kostuik 19701, but a lollow-up time beyond four years is unusual.How tibial osteotomy works remains debatable.The redistribution of weightbearing stresses, the relief of soft tissue tension by the correction of deformity and alteration of local blood supply all have their proponents.Analysis of the forces acting on the knee has been undertaken (Kettelkamp & Chao 1972) but whether such careful analysis to determine the angle of the osteotomy improves the results compared to merely straightening the affected limb by eye (Jackson & Waugh 1961) remains unproven.Various techniques for performing the osteotomy have been described ; ball and socket at or above the tibial tubercle (Jackson & Waugh 1961), transverse below the tubercle (Wardle 1962) and a closing wedge high above the tubercle (Gariepy 1961), with or without section of the fibula.Internal fixation techniques have also been described (Coventry 1965, Dcvas 1969) as alternatives to plaster cast immobilization post-operatively.The importance of accurate correction of the deformity has been