The management of early osteoarthritis

It is often stated that osteotomy does not work in the presence of exposed bone. The outcome of osteotomy depends on pre-operative planning, correct reduction and adequate fixation. However examples can be shown of patients who are fully active 10 years after upper tibial osteotomy achieving 135° flexion despite originally being bone-on-bone. It must also be recognised that persistent pain is present in up to 30% of patients following total knee arthroplasty (TKA) and they last for an average of 15 to 20 years. Unfortunately arthroplasty is also remunerated better than osteotomy. This and the separation of sports surgeons from arthroplasty surgeons have led to the decline in osteotomy. However we should be “comprehensive” knee surgeons and apply the full gamut of techniques for our patients’ benefit. The aim should be to preserve the knee joint and not replace it. This lecture is aimed at young surgeons, not dedicated arthroplasty ones, to consider the joint preserving techniques of meniscal reconstruction, cartilage preservation and osteotomy as advocated by John Nyland (University of Louisville, Kentucky, USA).