Abstract
Total knee replacement is an accepted standard of care for the treatment of advanced knee osteoarthritis with good results in the vast majority of older patients. The use in younger and more active populations, however, remains controversial due to concerns over activity restrictions, implant survival, and patient satisfaction with the procedure. It is in these younger patient populations that alternatives to arthroplasty are increasingly being explored. Historically, osteotomy was utilized to address unicompartmental pain from degeneration and overload, for example, after meniscectomy. Utilization rates of osteotomy have fallen in recent years due to the increasing popularity of partial and total knee arthroplasty. This article explores the indications and outcomes of traditional unloading osteotomy, as well as newer options that are less invasive and offer faster return to function.
Level of evidence V.
Similar content being viewed by others
References
Ackerman IN, Osborne RH (2012) Obesity and increased burden of hip and knee joint disease in Australia: results from a national survey. BMC Musculoskelet Disord 13:254
Amadi HO, Gupte CM, Lie DT, McDermott ID, Amis AA, Bull AM (2008) A biomechanical study of the meniscofemoral ligaments and their contribution to contact pressure reduction in the knee. Knee Surg Sports Traumatol Arthrosc 16:1004–1008
Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, Castoldi F, Rossi R (2014) Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 42:690–698
Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SM, Verhaar JA (2014) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 12:CD004019
Burstein D, Bashir A, Gray ML (2000) MRI techniques in early stages of cartilage disease. Invest Radiol 35:622–638
Burstein D, Gray ML (2006) Is MRI fulfilling its promise for molecular imaging of cartilage in arthritis? Osteoarthr Cartil 14:1087–1090
Burstein D, Velyvis J, Scott KT, Stock KW, Kim YJ, Jaramillo D, Boutin RD, Gray ML (2001) Protocol issues for delayed Gd(DTPA)(2-)-enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage. Magn Reson Med 45:36–41
Coventry MB (1965) Osteotomy of the upper portion of the Tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 47:984–990
Coventry MB (1984) Upper tibial osteotomy. Clin Orthop Relat Res 182:46–52
Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201
Danino B, Shabshin N, Schweitzer M, Halperin N (2005) Assessment of knee osteoarthritis on MR imaging under vertical weight-bearing conditions. J Bone Joint Surg Br 87:388
Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA (2014) Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 96:1425–1432
Duivenvoorden T, van Diggele P, Reijman M, Bos PK, van Egmond J, Bierma-Zeinstra SM, Verhaar JA (2015) Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3644-2
Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19:147–157
Faschingbauer M, Nelitz M, Urlaub S, Reichel H, Dornacher D (2015) Return to work and sporting activities after high tibial osteotomy. Int Orthop 39:1527–1534
Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF (1988) Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med 109:18–24
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2014) Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients. Int Orthop 38:55–60
Grunder W, Kanowski M, Wagner M, Werner A (2000) Visualization of pressure distribution within loaded joint cartilage by application of angle-sensitive NMR microscopy. Magn Reson Med 43:884–891
Hamada H, Nishii T, Tamura S, Tanaka H, Wakayama T, Sugano N (2015) Comparison of load responsiveness of cartilage T1rho and T2 in porcine knee joints: an experimental loading MRI study. Osteoarthr Cartil 23:1776–1779
Harris JD, McNeilan R, Siston RA, Flanigan DC (2013) Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction. Knee 20:154–161
Hinterwimmer S, Krammer M, Krotz M, Glaser C, Baumgart R, Reiser M, Eckstein F (2004) Cartilage atrophy in the knees of patients after seven weeks of partial load bearing. Arthritis Rheum 50:2516–2520
Hofmann S, Lobenhoffer P, Staubli A, Van Heerwaarden R (2009) Osteotomies of the knee joint in patients with monocompartmental arthritis. Orthopade 38:755–769; quiz 770
Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 255:215–227
Intema F, Thomas TP, Anderson DD, Elkins JM, Brown TD, Amendola A, Lafeber FP, Saltzman CL (2011) Subchondral bone remodeling is related to clinical improvement after joint distraction in the treatment of ankle osteoarthritis. Osteoarthr Cartil 19:668–675
Kanamiya T, Naito M, Hara M, Yoshimura I (2002) The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy 18:725–729
Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236
Li Y, Zhang H, Zhang J, Li X, Song G, Feng H (2015) Clinical outcome of simultaneous high tibial osteotomy and anterior cruciate ligament reconstruction for medial compartment osteoarthritis in young patients with anterior cruciate ligament-deficient knees: a systematic review. Arthroscopy 31:507–519
Linder-Ganz E, Elsner JJ, Danino A, Guilak F, Shterling A (2010) A novel quantitative approach for evaluating contact mechanics of meniscal replacements. J Biomech Eng 132:024501
Lobenhoffer P (2014) Importance of osteotomy around to the knee for medial gonarthritis. Indications, technique and results. Orthopade 43:425–431
Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138
Lobenhoffer P, Agneskirchner JD (2014) Osteotomy around the knee vs. unicondylar knee replacement. Orthopade 43:923–929
Madry H, Ziegler R, Orth P, Goebel L, Ong MF, Kohn D, Cucchiarini M, Pape D (2013) Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: analysis of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 21:39–48
Majima T, Yasuda K, Aoki Y, Minami A (2008) Impact of patellofemoral osteoarthritis on long-term outcome of high tibial osteotomy and effects of ventralization of tibial tubercle. J Orthop Sci 13:192–197
Mastrokalos DS, Papagelopoulos PJ, Mavrogenis AF, Hantes ME, Paessler HH (2008) Changes of the posterior meniscal horn height during loading: an in vivo magnetic resonance imaging study. Orthopedics 31:68
McDermott ID, Lie DT, Edwards A, Bull AM, Amis AA (2008) The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures. Knee Surg Sports Traumatol Arthrosc 16:553–560
Miller LE, Sode M, Fuerst T, Block JE (2015) Joint unloading implant modifies subchondral bone trabecular structure in medial knee osteoarthritis: 2-year outcomes of a pilot study using fractal signature analysis. Clin Interv Aging 10:351–357
Mosher TJ, Dardzinski BJ (2004) Cartilage MRI T2 relaxation time mapping: overview and applications. Semin Musculoskelet Radiol 8:355–368
Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP, Hirschmann MT (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23:2315–2323
Nieminen MT, Rieppo J, Toyras J, Hakumaki JM, Silvennoinen J, Hyttinen MM, Helminen HJ, Jurvelin JS (2001) T2 relaxation reveals spatial collagen architecture in articular cartilage: a comparative quantitative MRI and polarized light microscopic study. Magn Reson Med 46:487–493
Nishii T, Kuroda K, Matsuoka Y, Sahara T, Yoshikawa H (2008) Change in knee cartilage T2 in response to mechanical loading. J Magn Reson Imaging 28:175–180
Odenbring S, Egund N, Lindstrand A, Lohmander LS, Willen H (1992) Cartilage regeneration after proximal tibial osteotomy for medial gonarthrosis. An arthroscopic, roentgenographic, and histologic study. Clin Orthop Relat Res 277:210–216
Owman H, Tiderius CJ, Ericsson YB, Dahlberg LE (2014) Long-term effect of removal of knee joint loading on cartilage quality evaluated by delayed gadolinium-enhanced magnetic resonance imaging of cartilage. Osteoarthr Cartil 22:928–932
Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19:590–599
Schoenbauer E, Szomolanyi P, Shiomi T, Juras V, Zbyn S, Zak L, Weber M, Trattnig S (2015) Cartilage evaluation with biochemical MR imaging using in vivo Knee compression at 3T-comparison of patients after cartilage repair with healthy volunteers. J Biomech 48:3349–3355
Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J (2015) Open-wedge high tibial osteotomy and combined abrasion/microfracture in severe medial osteoarthritis and varus malalignment: 5-year results and arthroscopic findings after 2 years. Arthroscopy 31:1279–1288
Shiomi T, Nishii T, Tanaka H, Yamazaki Y, Murase K, Myoui A, Yoshikawa H, Sugano N (2010) Loading and knee alignment have significant influence on cartilage MRI T2 in porcine knee joints. Osteoarthr Cartil 18:902–908
Sitoci KH, Hudelmaier M, Eckstein F (2012) Nocturnal changes in knee cartilage thickness in young healthy adults. Cells Tissues Organs 196:189–194
Smith JO, Wilson AJ, Thomas NP (2013) Osteotomy around the knee: evolution, principles and results. Knee Surg Sports Traumatol Arthrosc 21:3–22
Souza RB, Kumar D, Calixto N, Singh J, Schooler J, Subburaj K, Li X, Link TM, Majumdar S (2014) Response of knee cartilage T1rho and T2 relaxation times to in vivo mechanical loading in individuals with and without knee osteoarthritis. Osteoarthr Cartil 22:1367–1376
Souza RB, Stehling C, Wyman BT, Hellio Le Graverand MP, Li X, Link TM, Majumdar S (2010) The effects of acute loading on T1rho and T2 relaxation times of tibiofemoral articular cartilage. Osteoarthr Cartil 18:1557–1563
Stehling C, Souza RB, Hellio Le Graverand MP, Wyman BT, Li X, Majumdar S, Link TM (2012) Loading of the knee during 3.0T MRI is associated with significantly increased medial meniscus extrusion in mild and moderate osteoarthritis. Eur J Radiol 81:1839–1845
Sterett WI, Steadman JR (2004) Chondral resurfacing and high tibial osteotomy in the varus knee. Am J Sports Med 32:1243–1249
Tanamas S, Hanna FS, Cicuttini FM, Wluka AE, Berry P, Urquhart DM (2009) Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis Rheum 61:459–467
Tibesku CO, Mastrokalos DS, Jagodzinski M, Passler HH (2004) MRI evaluation of meniscal movement and deformation in vivo under load bearing condition. Sportverletz Sportschaden 18:68–75
Tiderius CJ, Olsson LE, Leander P, Ekberg O, Dahlberg L (2003) Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in early knee osteoarthritis. Magn Reson Med 49:488–492
Tsukada S, Wakui M (2015) Is overcorrection preferable for repair of degenerated articular cartilage after open-wedge high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3655-z
Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement. An in vivo study using dynamic MRI. J Bone Joint Surg Br 81:37–41
White LM, Sussman MS, Hurtig M, Probyn L, Tomlinson G, Kandel R (2006) Cartilage T2 assessment: differentiation of normal hyaline cartilage and reparative tissue after arthroscopic cartilage repair in equine subjects. Radiology 241:407–414
Wiegant K, van Roermund PM, Intema F, Cotofana S, Eckstein F, Mastbergen SC, Lafeber FP (2013) Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthr Cartil 21:1660–1667
Ziegler R, Goebel L, Cucchiarini M, Pape D, Madry H (2014) Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part II: standard and overcorrection do not cause articular cartilage degeneration. Knee Surg Sports Traumatol Arthrosc 22:1666–1677
Ziegler R, Goebel L, Seidel R, Cucchiarini M, Pape D, Madry H (2015) Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part III: analysis of the microstructure of the subchondral bone and correlations with the articular cartilage and meniscus. Knee Surg Sports Traumatol Arthrosc 23:2704–2714
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Andreas H. Gomoll: Royalties (SBM Inc.); Henning Madry: None; Peter Angele: Aesculap, Arthrex, Orteq, Shabshin and Condello: NuSurface.
Rights and permissions
About this article
Cite this article
Gomoll, A.H., Angele, P., Condello, V. et al. Load distribution in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24, 1815–1825 (2016). https://doi.org/10.1007/s00167-016-4123-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-016-4123-0