Osteotomies of the knee joint in patients with monocompartmental arthritis

The basic principles of biomechanics, patient selection, proper planning, safe intraoperative technique with stable osteosynthesis, and early functional rehabilitation are the key factors for successful osteotomies around the knee. An individual unloading of the involved compartment should be the goal of this procedure. Several different osteotomy techniques have been described in the past. On the tibia, the modern open-wedge osteotomies offer significant advantages compared with the classical closed-wedge osteotomies. At the femur, closed-wedge medial and lateral osteotomies for varus and valgus malalignment are still the standard. Except for a few studies with selected patients, the long-term results of osteotomies around the knee are worse compared with the outcomes of unicondylar joint replacements. With the use of new biomechanical concepts together with modern osteosynthesis, osteotomy results can improve significantly. Therefore, osteotomies around the knee remain the gold standard for middle-aged and active elderly patients with monocompartmental arthritis of the knee.