Osteotomy around the knee is a surgical procedure that has evolved significantly over more than a century, with its foundational principles and techniques continuously refined to meet the needs of modern patients. This comprehensive review article traces the evolution of knee osteotomy, from its early, foundational years to the sophisticated, contemporary practices used today.
The Evolution of a Proven Treatment
The history of osteotomy can be categorised into three key periods. The Historical Period (pre-1940) saw the establishment of early techniques and foundational concepts, with pioneering surgeons recognising the importance of bone realignment to address knee deformities. This was followed by the Modern Early Years (1940-2000), marked by significant refinements in surgical methods and a deeper understanding of biomechanics. During this time, the procedure became a recognised treatment for unicompartmental osteoarthritis.
The Modern Later Years (2000-Present) have witnessed a revolution in the field. Contemporary practices now focus on precise patient selection, meticulous pre-operative digital planning, and the use of advanced surgical fixation techniques. This has led to the adoption of accelerated rehabilitation protocols, with some modern methods allowing patients to bear full weight within 24 hours of surgery.
Core Principles of Modern Osteotomy
The fundamental principle of knee osteotomy is to correct malalignment, thereby redistributing weight from the damaged, arthritic area of the knee to the healthier side. This crucial realignment helps to relieve pain, slow the progression of arthritis, and prolong the life of the natural knee joint.
Modern knee osteotomy is a highly effective biological treatment for a range of conditions, including:
- Degenerative Diseases: Correcting deformities associated with osteoarthritis.
- Deformities: Addressing conditions like ‘bowed legs’ (genu varum) and ‘knock knees’ (genu valgum).
- Knee Instability: Providing a valuable solution for instability, often in combination with other ligament repair procedures.
- Adjunct Procedures: It is also used in conjunction with other complex surgeries to enhance overall outcomes.
With a focus on preserving the patient’s own joint anatomy, modern osteotomy provides a viable alternative to knee replacement surgery, particularly for younger, more active individuals. It allows them to maintain a high level of physical activity for many years.
Professor Wilson’s Comments
“I’m extremely proud of this paper, completed early in my career with my colleague Neil Thomas. Together, we set out to examine the evolution of osteotomy surgery — exploring what was done historically, how techniques had developed over the decades, and where we stood with modern osteotomy practice at the time of writing.
The paper was recognised with the Best Paper Award at the ESSKA Congress in Amsterdam (2014) and has since become a highly cited reference in the field.
It provided surgeons with a clear and structured overview of the evolution of osteotomy, guiding understanding of how far the specialty had advanced and shaping thinking around modern surgical strategies. It also formed the basis for a lecture I delivered frequently on the history and evolution of osteotomy, helping to educate and inspire colleagues worldwide.
This work remains a key milestone in highlighting the transformation of osteotomy into a precise, planned, and evidence-based discipline.”
To delve into the complete findings, methodology, and analysis, the full research paper is available for your review:
Osteotomy Around the Knee: Evolution, Principles and Results
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/23052110/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8313165/
- https://profadrianwilson.co.uk/knee-treatments/knee-realignment-surgery-osteotomy/
