Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. 1965.

Attempts to treat degenerative arthritis of the knee by surgical means have been limited. Patellectomy or patelloplasty may be done in the presence of symptomatic patellofemoral arthritis; and joint dkbridement, including removal of loose bodies, large osteophytes, and damaged menisci, is occasionally used. Arthrodesis and arthroplasty are seldom carried out. Most patients with degenerative arthritis of the knee bear more of their weight on one tibial condyle than on the other. The male knee normally tends toward a varus position, the female toward a valgus position. As the articular cartilage degenerates over the tibial condyle that bears the most weight, the natural varus or valgus deviation increases and a vicious circle is set up in which increasing deformity creates increasing degenerative change. The uninvolved condyle and joint space usually appear normal. If weight-bearing and other stresses could be increased on this more normal area and decreased on the involved portion, it would seem that pain might be relieved and the useful life-span of the knee joint considerably prolonged. In 1961, Jackson and Waugh described a ball-and-socket type of osteotomy of the tibia just below the tibial tubercle (and osteotomy of the fibula at itsmiddle third) to correct the deformity created by osteo-arthritis. They reported on ten patients and stated that all had been relieved of their pain. In 1962, Wardle reported on tibial osteotomy for degenerative arthritis of the knee and stated that this type of operation had been done in Liverpool since the time of Sir Robert Jones. Wardle's osteotomy was transverse and about four inches distal to the tibial tubercle. The fibula was osteotomized a t about the same level. Wardle stated that all but three of seventeen patients remained free of pain and had 90 degrees or more of flexion following osteotomy. Macintosh used an endoprosthesis to replace and shim the more degenerated of the two tibial condyles, correcting the deformity in this way. In a preliminary report he stated that eight of thirteen patients achieved good results, two fair results, and three poor results. Stimu!ated by the relief of hip pain observed after intertrochanteric osteotomy which altered weight-bearing surfaces and corrected deformity and further encouraged by the report of Gari6py's1 lateral approach to the upper part of the tibia for the correction of flexion deformity in rheumatoid arthritis, I attempted to produce a somewhat different type of osteotomy proximal to the tibial tubercle. This modification is designed to fulfill six criteria. The osteotomy should (1) fully correct and, in fact, slightly reverse the varus or valgus deformity, (2) be near the site of the deformity, (3) involve bone that will heal rapidly-the bone should be primarily cancellous, (4) allow early motion of the knee and early bearing of weight, (5) provide convenience for exploration of the knee a t the time of osteotomy, if such is indicated, and (6) present no undue technical d8iculties or potential hazards. In * 200 First Street, S.W., Rochester, Minnesota 55902.