Knee osteotomy: indications and results
This video explores the indication for osteotomy in medial compartment gonarthrosis, emphasizing preoperative assessment, long-term results, and the benefit in athletes or in cases of ligament laxity.
Doctors
Topics
Treatments
Advice
- Dr Jacques Vallotton
- Indications for osteotomy
- Surgical planning
- Correction techniques
- Results in sports
- Knee preservation
- Tibial osteotomy
- Partial denture
- Ligament reconstruction
- Avoid overcorrection
- Offer osteotomy early for best results
- Combine if necessary with ligament reconstruction
- Adapt to bone morphology
Why consider an osteotomy in gonarthrosis
In predominantly medial compartment gonarthrosis, pain often results from excessive loading due to a varus morphotype. Tibial realignment osteotomy aims to redistribute stress by shifting the load toward the healthy area, without directly intervening on the joint. It is a relevant conservative option in active patients with non-extreme osteoarthritis and compatible menisci/ligaments.
This surgery remains too little known, even though it can significantly delay prosthesis replacement. When performed at the right time, it improves pain and function at the cost of a low risk of complications when the indication and planning are controlled.
Selection and planning: the keys to results
Success depends on a complete clinical and radiological assessment: pain topography, osteoarthritis stage (ideally ≤ grade 2), analysis of the mechanical axis, patellofemoral and opposite compartment status, weight, activity level and laxity. The objective is normocorrection: avoid valgus overcorrection which shifts the problem to the other compartment, as well as undercorrection which allows symptoms to persist.
Precise planning of the osteotomy line, the degree of opening and the fixation material determines the consolidation and harmonious distribution of loads. Informing the patient about the initial unloading and the gradual resumption of weight-bearing is an integral part of the protocol.
Osteotomy remains an effective therapeutic option in early gonarthrosis.
Technique and biomechanical principles
Osteotomy corrects extra-articular bone deformity (tibial varus) to rebalance the mechanical axis. Correction is achieved by medial opening (or sometimes lateral subtraction), stabilized by plate/wedge until consolidation. The objective is to recenter the load line in the middle of the knee, respecting ligament kinematics.
Meniscal preservation is encouraged when possible. Normocorrection allows for future options: in the event of osteoarthritic progression, a unicompartmental or total prosthesis remains technically feasible with good results when the axis has been corrected without excess.
Athletes and laxity: extended indications and associations
In athletes with varus and instability (ACL deficiency), osteotomy can be combined with ligament reconstruction to restore stability and load distribution. Studies report returns to a high level of activity with good functional balance when the axis is corrected without overcorrection.
In some advanced cases with irreversibly damaged internal compartment, a partial prosthesis can be combined with osteotomy to optimize alignment and kinematics. Here again, selection and planning guide the choice.
We must not miss the boat to propose the osteotomy at the right time.
Complications, Outcomes, and Realistic Expectations
When the technique is mastered and the indication is well established, complications are rare. Long-term series show high survival rates and lasting benefits on pain and walking. Recovery involves progressive weight-bearing and a structured physiotherapy program, targeting range of motion, strength and proprioception.
Expectations should be aligned: osteotomy does not "cure" osteoarthritis but rebalances the knee to gain function and postpone the need for a prosthesis within a coherent care pathway.
Message to the patient: correct the axis to protect the joint
Osteotomy offers a credible conservative alternative for young, active patients with early medial gonarthrosis and varus. By correcting the axis, it relieves overloaded areas and promotes more fluid movement, an essential condition for resuming activities without increasing wear and tear.
At this stage, individualized support—from planning to rehabilitation—remains the best guarantee of lasting results. The decision is made on a case-by-case basis, taking into account body type, life goals, and anticipated developments.
Your pain has a cause.The balance sheet allows us to understand it.
- Gait analysis
- Posture Assessment
- Guidance on the right treatment
- Study of plantar supports and supports
- Detection of compensations
- Pain–movement correlation
The functional assessment allows us to understand how a joint or postural imbalance can trigger or perpetuate pain. Very often, imaging is normal, but movement is disturbed. By analyzing gait, weight-bearing patterns, or posture, we identify the weak links in the chain and guide targeted treatment adapted to the patient's actual mechanics.
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