This chapter explores the vital role of meticulous surgical planning in performing osteotomies around the knee, a key biological treatment for a range of conditions. It highlights that a detailed preoperative plan not only ensures patient safety but also equips the surgeon to effectively manage potential complications. The authors offer practical guidance on surgical techniques, complication management, and the decision-making process for patient selection.
Key Surgical Insights and Techniques
The chapter provides a framework for surgeons performing high tibial osteotomy (HTO) and distal femoral osteotomy (DFO), emphasising a checklist approach to ensure all essential steps are considered. This includes a recommendation for bone graft augmentation in open wedge HTO to promote optimal healing and reduce postoperative pain, a technique which is preferred over leaving the gap unfilled. It also discusses the various risks and complications associated with osteotomies and offers insights into effective strategies for risk reduction and complication prevention.
Deciding Between HTO and Joint Replacement
A crucial part of the discussion focuses on the criteria for choosing between a knee osteotomy and a unicondylar prosthesis (UKP). The authors provide clear decision criteria, taking into account several factors such as the patient’s constitutional deformity, ligament balance, and the degree of osteoarthritis. This patient-specific approach ensures that the most suitable treatment is selected, aiming to deliver predictable and beneficial long-term outcomes.
Professor Wilson’s Comments
“As part of a long-standing collaboration with friends and colleagues over many years, we’ve worked together across a number of different entities — through our ESSKA committee roles, advocacy work, and international osteotomy teaching. We began with the original Basingstoke course, which became an annual event before evolving into the London Osteotomy Course, and from there our teaching expanded across the globe. We’ve since been invited to speak and perform live surgical demonstrations throughout the United States, India, South America, Japan, and across Europe, sharing the innovations we helped pioneer.
In parallel, our close partnership with Newclip led to the creation of the Scientific Advisory Board (SAB), which I co-founded. This group has been instrumental in driving forward new ideas in osteotomy and fixation technology. Through the SAB and our international engagements, we have continually refined surgical techniques and supported the evolution of modern osteotomy practice.
This particular review paper, published in 2018, is a nice example of that journey. It provides an overview of the history and development of osteotomy — from the early Puddu plate to the TomoFix system, and then to the advanced Newclip fixation platform. By this time, our group had refined the hinge wire concept and had begun developing the hinge screw. We also introduced the double-window technique for high tibial osteotomy (HTO), which allows protection of the MCL and, more importantly, safeguards the neurovascular bundle posteriorly using our CARE+ retractor — an innovation we pioneered and introduced in collaboration with the Newclip team.
Overall, this paper serves as a concise and informative summary of the major innovations that have shaped osteotomy surgery, reflecting the collective experience and dedication of our international team.”
The full research paper is available for an in-depth review of the complete findings, methodology, and analysis.
Osteotomies: The Surgical Details You Want to Know
Sources used in report overview:
- https://www.nyp.org/orthopedics/osteotomy
- https://www.physio.co.uk/what-we-treat/surgery/knee/osteotomy.php
- https://www.aofoundation.org/recon/clinical-library-and-tools/scientific-articles/08_2_preview_unicompartmental-knee-arthroplasty-versus-high-tibial-osteotomy
