Proximal tibial osteotomy in medial compartment osteoarthritis: How high is high?

Abstract

Proximal tibial osteotomy (PTO), which can be performed using various techniques, is a common procedure for the treatment of medial compartment osteoarthritis of the knee. Changes in the biomechanics of knee may cause problems in the long term, depending on the technique that was performed. Whichever technique is used, the level at which the osteotomy is performed is a significant factor in any changes in biomechanics and for potential problems in future surgery. The relationship between the techniques applied and the names used throughout its progression is investigated in this review, which briefly evaluates the historical improvement of PTO applied in the treatment of knee osteoarthritis. Denomination defined by the first practitioners of different osteotomies that were used in the treatment of knee osteoarthritis and identified under different names were investigated in the literature. Compatibilty of technique defined by using the word "high" and different techniques were evaluated. The contribution of alteration in surgical techniques on nomenclature has lead to standard usage with time. The term "high", which has been used for longer than four decades, does not cover all of these techniques. Nomenclature of osteotomies performed for the treatment of medial compartment osteoarthritis would therefore be more appropriate, if it were used in such a way as to define the actual level of osteotomy. We believe that osteotomies performed distal to the tibial tubercle must be defined as 'upper tibial' or 'proximial tibial' instead of 'high', or related osteotomy level and method must be clearly stated in each individual case.