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© 2021 THE AUTHORS. ORTHOPAEDIC SURGERY PUBLISHED BY CHINESE ORTHOPAEDIC ASSOCIATION AND JOHN WILEY & SONS AUSTRALIA, LTD.

REVIEW ARTICLE

Osteotomy Around the Knee: The Surgical

Treatment of Osteoarthritis
Haining Peng, MS1, Aichun Ou, BS2, Xiaohong Huang, PhD3, Chen Wang, MS1, Lei Wang, MS1, Tengbo Yu, PhD1,4,
Yingze Zhang, PhD5,6, Yi Zhang, PhD1,4,7

Department of 1Sports Medicine, 2Operating Room, 6Orthopedics and 7Shandong Institute of Traumatic Orthopedics, Affiliated Hospital of
Qingdao University, 3Institute of Neuroregeneration and Neurorehabilitation, Qingdao University and 4Institute of Sports Medicine and
Rehabilitation, Qingdao University, Qingdao and 5Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang,
China

Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays,
clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conserva-
tive treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe
degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with
low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of “knee
preservation,” has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the
mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure
and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti-
varus deformity and anti-valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the
knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correc-
tion of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur
osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on tra-
ditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clin-
ical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied
widely in clinical practices.
Key words: Distal femur osteotomy; mechanical axis; High tibial osteotomy; Knee osteoarthritis; Osteotomy around the
knee joint; Proximal fibular osteotomy

Introduction between the medial and lateral compartments, reduce the

K nee osteoarthritis (KOA) is a common chronic disease

causing joint pain and functional disorders in 30% of
>60-year-old people1, 2. In addition to age and obesity, the
pressure borne of the cartilage and subchondral bones by
correcting the mechanical axis with bone cutting4. OAK can
relieve joint pain and improve joint function. Due to the fact
abnormal mechanical factor plays a critical role in the patho- that osteotomy retains the anatomical structure of the joint,
genesis of osteoarthritis3.The mechanical axis deviation in it has the advantages of proprioception preservation and
the lower limbs causes the varus or valgus deformity, which rapid recovery of joint functional efficacy, which greatly
affects the load-bearing force of the medial and lateral knee delays the progression of osteoarthritis. OAK thus better
joint compartments, and increases the pressure held by the suits relatively young and high-demand patients.
cartilage and subchondral bones. This in turn accelerates the There are many techniques for correcting the mechani-
mechanical axis deviation in lower limbs, which eventually cal axis of OAK. We conducted a structured literature search
worsens the progress of osteoarthritis. The principle of osteo- in the PubMed, Cochrane, ProQuest, and Web of Science, to
tomy around the knee (OAK) is to rebalance the force identify studies published between January 1965 and 2020

Address for correspondence: Yi Zhang, PhD, Department of Sports Medicine, The Affiliated Hospital of Qingdao University, 59 Haier Road, Laoshan
District, Qingdao, China 266000; Email: [email protected]
Received 7 September 2020; accepted 21 March 2021

Orthopaedic Surgery 2021;13:1465–1473 • DOI: 10.1111/os.13021

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
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using the search string “knee osteoarthritis” or “varus defor- and-socket osteotomy below the tibial tubercle has been
mity” or “valgus deformity” or “gonarthrosis” or “mechani- reported by Jackson and Waugh11 as significantly improving
cal axis” AND “high tibial osteotomy” or “proximal fibular the postoperative survival rate (cumulative survival with con-
osteotomy” or “distal femur osteotomy” or “osteotomy version to arthroplasty)12, 13. The classical approach of HTO
around the knee joint.” We manually reviewed reference lists has some complications, including neurovascular injury,
in all retrieved articles for related publications (Fig. 1). under correction, and facture14–16, yet improvement in the
Inclusion criteria were: studies investigating either surgical techniques has earnt HTO widespread attention in
osteotomy around the knee joint and/or osteotomy; studies recent years.The strategy for correcting the medial compart-
reporting original human data; and studies that introduced ment arthritis with varus deformity is based on cartilage
relevant techniques and modified techniques. Exclusion non-progressive injury area17, i.e. 30%–40% of the lateral tib-
criteria were: animal studies; cellular studies; studies with less ial plateau. It is recommended that 62.5% away from inner
than three subjects per group; case reports; letters to the edi- side of the tibial plateau (Fujisawa point) should be the
tor and editorials; and publications not reporting original aiming point for correcting the mechanical axis18.
data. The aim of this paper is to provide an overall evalua- The operation of HTO needs to consider the age of
tion for clinical treatments through reviewing the different patients and their functional requirements, the position and
types of OAK that have been reported in clinical practices severity of knee joint deformity, and the progression of the
for treating knee osteoarthritis. disease:
1. Age: HTO, reserving the anatomical structure of the knee
Anti-varus Deformity Osteotomy joint, is more important for people who need joint preser-

B iomechanically, 60%–80% of load bearing is transmitted

to the medial compartment of the knee joint in normal
gait5. And the involvement degree of the medial compart-
vation, especially relatively young patients. The surgery is
usually recommended for patients less than 60 years of
age19.
ment is 10 times that of the lateral compartment6. Therefore, 2. Varus deformity: It has been indicated in the previous
medial compartment osteoarthritis with varus alignment and studies that the postoperative consequence is better when
medial space stenosis is more common compared to lateral the tibia bone varus angle (TBVA) is more than 5 or the
compartment osteoarthritis, accounting for about 74% of medial proximal tibial angle (MPTA) is less than 85 19.
patients with KOA7. To reallocate the force bearing from the 3. The disease progression: The degree of cartilage abrasion
medial to the lateral compartment,the anti-varus osteotomy, does not affect the correction outcome of osteotomy20.
including high tibial osteotomy (HTO) and proximal fibular However, it is difficult for patients with severe sub-
osteotomy (PFO), corrects the mechanical lines of lower chondral bone abrasion to achieve satisfactoriness
extremities using surgical methods, which alleviates the abra- after HTO.
sion of medial cartilage and relieves pain8.
Medial Open-Wedge High Tibial Osteotomy
High Tibial Osteotomy (HTO) The methodology of medial open-wedge high tibial osteo-
High tibial osteotomy (HTO) is an accepted surgical treat- tomy (MOWHTO)21 is to perform oblique cutting at the
ment in medial compartment arthritis8–10. An effective ball- medial side of the tibia and implant bones in the gap after

Fig 1 Study selection process.

Preferred reporting articles for this
review flow diagram.
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the wedge is extended. It is necessary to keep the lateral tibial the anterior cortex of tibia), whereby the angle between the
cortex intact. The 10-year survival rate of MOWHTO is as two cut lines is about 110 . The upper incision method pre-
high as 91.6% and the life-long survival rate is over 65%22. vents the tibia from rotating. However, the patellar des-
Early applications of the surgery entail a single-plane osteo- cending, causing pain in anterior knee and limiting joint
tomy, which affects the patella position and the tibia poste- function, remains a problem.
rior tilt in the sagittal plane. Therefore, efforts have been The subsection method, by modifying the operation
made for long-term and stable treatment results, like the dif- and practicing distal tuberosity osteotomy (DTO) (Fig. 2),
ferent approaches of osteotomy, the stabilizing devices, and keeps the tuberosity attached to the proximal tibia24. After
the newly implanted materials23–25. The modified techniques, internal fixation of the osteotomy, a bicortical screw is used
including dual-plane osteotomy, fixation devices, the external to fix the distal tuberosity to the tibia. The sub-
fixator, and the absorbable mesh gasket, are developed in section procedure effectively prevents post-osteotomy patel-
response to improve the effectiveness of the procedure. lar from descending, which overcomes the shortage of
superior incision, especially in patients who need a major
Dual-Plane High Tibial Osteotomy. Early practices of dual- anti-varus deformity correction for medial compartment
plane high tibial osteotomy, also known as the superior inci- osteoarthritis.
sion, were performed at the proximal tibial tuberosity (PTO)
(Fig. 2), employing a horizontal plane incision (cutting off Fixation Device. HTO requires higher internal fixation to
the inner and posterior cortex of tibia) and an oblique inci- maintain joint stability. However, classical plates hardly meet
sion behind the tuberosity in the coronal plane (cutting off the need, which results in losing the corrected angle after the

A B C

D E F

Fig 2 Medial open-wedge high tibial osteotomy (MOWHTO) with proximal tibial tuberosity (PTO) and MOWHTO with distal tuberosity osteotomy (DTO).
The a-c indicate the methodology of MOWHTO with PTO. (A) before opening of the wedge, AP-view; (B) after opening of the wedge, AP-view; (C) after
opening, lateral view. The d-f indicate the methodology of MOWHTO with DTO. (D) before opening of the wedge, AP-view; (E) after opening of the
wedge, AP-view; (F) after opening, lateral view. The figure was adapted from Gaasbeek et al.24
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operation23, 26. To overcome the difficulty, different fixation achieve best satisfactory improvement for knee osteoarthritis
techniques were described. The Puddu plate and TomoFix patients who have varus deformity between 10 and 15 38.
are the two most commonly used devices27. The original
Puddu plate28 was described as a fixation device including
the plate, screw, and a metallic block configuration, for dis- Lateral Closing Wedge High Tibial Osteotomy
tracting medial corticalis and supporting extra pressure27. Lateral closing wedge high tibial osteotomy (LCWHTO) was
The first generation Puddu plate can withstand the axial first invited by Coventry39, which has been the standard
loading of the proximal tibia29. The modified one through method for many years. By removing a wedge-shaped bone
LHS holes makes orientating the screws possible30. block laterally, retaining the inner hinge, and closing the gap,
TomoFix, a new locking compression plate (LPC), is a the procedure effectively relieves the symptom of pain and
T-shape plate including horizontally locking screw holes and improves joint mobility functions combined with proximal
longitudinally combining holes26. TomoFix plates have better fibular osteotomy. Its 20-year survival rate achieves 80% suc-
stability and elasticity to maintain the correction without cess. It is noteworthy that, especially for young patients, the
using bone to fill the gap. The excellent stability of the LPC joint stability is immediately improved and the healing time
can upgrade the postoperative load bearing, meanwhile the is shortened40–42. However, several complications have been
elasticity augments the contact between bones and facilitates reported in procedure, including nerve injuries, bone non-
bone healing31. union, and infection23. Duivenvoorden et al.43 report that
The finite element analysis (FEA) is widely accepted in around 4% of the postoperative patients have peroneal nerve
data research32,33. Some previous FEA compared different palsy. Therefore, modification of surgical techniques is still
plates, the researchers concluded that the TomoFix plate needed to minimize the adverse effects.
produces superior compression and torsion stability than
Puddu plate27,34. Current literature mostly indicates that
TomoFix plate is the optimal choice for internal fixation. Improved Lateral Closing High Tibial Osteotomy. The tradi-
tional LCWHTO affects the biomechanics of the
patellofemoral joint, decreasing the tibia posterior tilt by
Ilizarovtype Circular External Fixator. Ilizarovtype circular
approximately 5 , which results in increased force bearing of
external fixation was developed to render better rotational
the cruciate ligament44. Huang et al. improved the surgery
stability and rapid fullweight bearing for the joint35. Cengiz
by making the spot of osteotomy in the distal tibial tubercle
et al.36 indicate that the external fixation maintains precise
instead of the proximal tibial tuberosity, and using TomoFix
correction and bone stock after surgery. However, it has a
plate for internal fixation45. It has been indicated that the
high risk of pin-track infection35, 37 and is not widely used
modified surgery avoids the adverse impact on the
in clinical practice. Comparing the effects between internal
patellofemoral joint movement and the reduction of the tib-
and external fixation on postoperative stability, the internal
ial slope, which effectively relieves postoperative pain and
fixation is believed to have a higher whole stability and a
other symptoms. At present, this method is commonly
lower infection risk, and it is recommended in clinical
applied to young patients and patients with excessive knee
application.
varus deformity.

High Tibial Osteotomy Embedded in Absorbable Mesh

Gasket. Several problems in HTO have been exposed in the Dome-Shaped High Tibial Osteotomy
early practices, such as complete fracture of tibia and second- Compared with wedge-shaped osteotomy, dome-shaped
ary operation to remove internal fixation. Yingze Zhang osteotomy preserves the natural shape of the proximal tibia,
et al.25 first used the technique of propping up the medial maintains the length of lower limbs, and shortens the bone-
platform, which uses an absorbable gasket material, com- healing period, without affecting the joint replacement sur-
bined with a lateral fibular osteotomy to treat medial com- gery afterwards. The method was invited and laterally popu-
partment arthritis. It has been reported that the knee joint larized46. Dome-shaped high tibial osteotomy (DSHTO)
function of the postoperative patients can be favorably (Fig. 3) is used to correct the mechanical axis of lower limbs
improved within 6–12 months, with pain relief and fewer by removing a marginal amount of bones to generate rota-
complications. The absorbable gasket is mainly composed of tion effect. Different from the linear displacement correction
hydroxyapatite and collagen. The pores of the material are method in wedge osteotomy, DSHTO minimizes distance
conducive for bone healing and growth, and the barbs can alteration between tibial tubercle and joint line, whereby, it
prevent the gasket from slipping out the gap. Moreover, the better maintains the position of patella. Even to the young
absorbability of the gasket prevents the trauma by secondary patients who have failed in LCWHTO correction,the applica-
removal operations.The modified technique maintains the tion of DSHTO surgery can achieve improvement47. How-
lateral tibial cortex which belongs to the incomplete fracture. ever, due to the large intraoperative exposure and
Therefore, the procedure does not obstruct early postopera- complicated surgical techniques, DSHTO is rarely used in
tive weight bearing. The absorbable pads are reported to clinical practice.
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A B

D E

Fig 3 The method dome-shaped hightibial osteotomy. (A) Series of 2.5-mm drill holes marked on a curved line above the tibial tuberosity. (B) Two
Steinmann pins inserted on either side of the osteotomy to define angular correction. (C/D) Sagittal view: the distal tibia brought forward
approximately 10 mm. (E) When desired angle is achieved, the TomoFix plate fix fragments are applied under compression. The figure was adapted
from Diogo et al.47

L-Shaped High Tibial Osteotomy imbalanced tension between internal and external soft tissues
L-shaped high tibial osteotomy (LHTO), known as tibial remain unchanged.
condyle valgus osteotomy (TCVO), is an open intra-articular
osteotomy, which was developed by Chiba et al 48.The “L- Navigated Knee Osteotomy
shaped” part of the term refers to the section from the proxi- HTO is a technically demanding, highly accurate procedure.
mal tibia to the intercondylar spine (Fig. 4). The procedure The clinic results of HTO also depends on the degree of the
aims to contact tibia with the lateral femoral condyle after accurate correction15. The failure may occur if the postopera-
the osteotomy. The advantage of LHTO is multi-operations, tive malalignment is unreliable. As in the previous studies,
i.e. it allows more than one multi-dimensional and multi- some computer-assisted surgery (CAS) technologies have
planar corrections all at one time. Its effectiveness has been been used in preoperative planning50,51. These can help to
confirmed in many studies, including correct joint instability simulate surgery and predict possible outcomes50. However,
and lower limb alignment48. TCVO is applied to patients there are not enough satisfying ways to achieve the mechani-
with intra-articular deformity in the middle and late stages. cal axis intraoperatively.
However, experts claim that classical extra-articular osteo- The insufficient intraoperative visualization results in
tomy technique cannot correct intra-articular deformities49. postoperative malalignment and surgical failure52. Mean-
TCVO also has a limited angle of varus correction. It cor- while, exact intraoperative mechanical axis is a tough clinical
rects the tibia from valgus deformity into lateral joint reduc- problem. Laterally, the intraoperative system has been devel-
tion, rarely changing to the mechanical lines of the entire oped to help the intraoperative procedure53,54. The technique
lower limb or the surrounding soft tissues, whereby the of momentary evaluation includes the cable method which
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A B C

Fig 4 The methodology of the L-shaped high tibial osteotomy. (A) an L-shaped osteotomy from the medial side of the proximal tibia to the
intercondylar eminence. (B,C) the weight-bearing line is shifted out and the lateral subluxation joint is reset after correction. The figure was adapted
from Chiba et al.48

uses diathermy cable to span, the grids with leading impreg- fibula on the lateral side, the load bearing axis shifts to the
nated reference lines and the radiologic measurement55–57. medial compartment, accelerating the settlement rate of the
Nowadays, the usefulness of the navigated system in medial platform63. It is the reason that PFO was brought up
HTO is gradually attracting attention. Ellis et al. first devel- to treat medial knee osteoarthritis64. Liu et al.65 revealed the
oped software that increased the accuracy of removing wedge relationship between preoperational factors and postopera-
intraoperatively with the need of preoperative CT scan53. tive outcome: the outcome of PFO is related to the value of
With the awareness of radiation exposure and infection58, the settlement which reflects the supporting effect of the lat-
the CT-free OrthoPilot® system was developed. The naviga- eral fibula. Previous studies indicate that PFO can increase
tion has reported successful outcomes59. It can effectively femorotibial angle by 1 to 5 , meanwhile the pressure on
prevent the loss of correction and increase the accuracy of medial knee joint can be reduced by 10% to 30%66.
intraoperative alignment60. According to the Kellygren–Lawrence’s classification of knee
The preoperative planning and the intraoperative sys- arthritis, patients with knee arthritis grades II and III are rec-
tem are related long-term outcomes. The way of taking a ommended PFO surgery67, 68. Therefore, PFO is mainly con-
radiograph in the preoperative planning stage can result in sidered for patients with early knee varus deformity and
the difference of accuracy61. medial space stenosis.
PFO is a simple, trauma-minimized, and effective pro-
cedure that enables patients to perform rehabilitation exer-
Proximal Fibular Osteotomy (PFO) cises and bear weight at earlier postoperative stage69. Thus,
Proximal fibular osteotomy (PFO) is based on the “non- PFO is widely used in recent decades. However, PFO surgery
uniform settlement” theory proposed by Yingze Zhang may destroy the peroneal nerve, accompanied with the clini-
et al.62.It indicates that osteoporosis triggers the non-uniform cal manifestations, including the weakness of the dorsal
settlement and degeneration, by decreasing the number of extension of foot and numbness and decreased sensation on
bone trabeculae and the ability of bone to disperse pressure the back of foot and ipsilateral lower leg. However, the side
leading to microfracture62. It is to cut small section of the effect can be gradually relieved by symptomatic treatment70.
proximal fibula, i.e. below the fibula head, which breaks the
fibula and weakens its support for the lateral of the tibial pla-
teau. As such, the muscle attached to proximal fibula, in the Anti-valgus Deformity Osteotomy
situation of the weight-bearing, can pull the fibular head
along the distal direction, and the tension is transmitted to
the lateral femoral condyle. Eventually, the gap on the lateral
L ateral compartment gonarthrosis which leads to valgus
deformity accounts for about 16% of knee arthritis cases.
The causing reason includes lateral meniscus injury, obesity,
side of the knee joint is reduced to offset the knee varus and so on. Valgus deformity reduces the knee adduction
deformity caused by weight bearing. With the support of ability, causing the joint weight bearing to move towards the
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TABLE 1 The summary of different types of osteotomy around the knee

Style Advantages Disadvantages References

HTO 1. Standardization 1. Neurovascular complications Agliettiet al. 14

2. Various types 2. Facture Sprenger et al. 15
3. Delayed union and nonunion Wu et al. 16
4. Infection Kim et al. 22
5. Thromboembolic disease Coventry et al. 39, 75
6. Compartment syndrome
7. Under correction and recurrence of deformity
PFO 1. Simple 1. Neurovascular complications Dong et al. 63
2. Trauma-minimized 2. Compartment syndrome Zhang et al. 64
3. Delayed union and nonunion Yang et al. 70
4. Conversion to total knee arthroplasty Wang et al. 69
DFO 1. Accurate correction 1. Iliotibial band irritatio Puddu et al. 77
2. Not affect the range of motion 2. Leg length discrepancy Dewilde et al. 78
3. Delayed union and nonunion Saithna et al. 80
Jacobi et al. 81
Marti et al. 85

DFO, distal femur osteotomy; HTO, high tibial osteotomy; PFO, proximal fibular osteotomy.

lateral compartment71. Anti-valgus deformity osteotomy irritates the iliotibial band and the long bone healing time.
maneuvers the load bearing to the medial side to correct the Jacobi and his colleagues81 studied the postoperative compli-
force line of lower limbs, thereby, it rebalances the load bear- cations of the lateral open wedge osteotomy. They found that
ing among different compartments. Anti-valgus deformity is it took 9 months for bone to knit together properly in one
to settle the load bearing point in the 48%–50% area of the case, and 86% of the patients have symptoms of iliotibial
tibial plateau width from medially to laterally. Moreover, the band irritation.
corrected angle of the osteotomy is formed by the straight
lines from the femoral head and the center of the talus to Distal Femoral Medial Closing Wedge Osteotomy
50% of the tibial plateau, following the correction plan The closed wedge-shaped osteotomy of the medial femur
designed by Dugdale et al.72 It is suitable for young patients was first proposed and popularized to the clinical application
with earlier lateral knee osteoarthritis and lateral femoral by Coventry74. The line of force were corrected by cutting
condyle cartilage injury. the wedge-shaped bone block off the medial femur. The bone
healing time is shortened due to the compression fixation
Distalfemur Osteotomy (DFO) plates, and the irritation of soft tissues is reduced by the
Distalfemur osteotomy (DFO) was recommended as an alter- medial approach.
native treatment for lateral osteoarthritis73, the correction Backstein et al.82 exemplify the complete recovery of
osteotomy is usually applied locally where the deformity patients’ knee function after distal femoral lateral open-
occurs. However, studies indicate that when the valgus defor- wedge osteotomy, and the postoperative 10-year survival rate
mity exceeds 12 or the joint surface deviates from the hori- can reach 87%83, 84. However, the correction angle depends
zon to more than 10 74, the deformity should be corrected on the size of wedge-shaped bone block85. The corrective
on the femur site, even if the deformity occurs on the tibia. accuracy is limited owing to the precise bone wedge and the
Otherwise, it is more likely for the tibia to subluxate laterally, medial approach. The medial wedge-shaped osteotomy may
which causes knee joint instability75. cause undesirable consequences such as the leg length dis-
crepancy. This surgery, nevertheless, is commonly used in
Distal Femoral Lateral Open-Wedge Osteotomy clinical application, as it avoids the complications in lateral
The lateral open wedge osteotomy, first proposed by Puddu open surgery.
et al.76, adjusts the lower limb force line based on the gap
size and uses internal fixation to stabilize the osteotomy site. Tibial Medial Closing Wedge Osteotomy
It maintains the corrected angle, and avoids shortening the In addition to distal femoral lateral open-wedge osteotomy,
lower limbs77. The procedure is suitable for young patients Coventry75 has proposed the proximal tibial osteotomy as
with knee valgus and loose ligaments. Moreover, it has been another treatment to correct valgus deformity. By realigning
indicated in many studies that the lateral open surgery has a the proximal tibia and releasing the pressure of lateral com-
stable outcome with a 10-year survival rate at around 74%78– partment, the surgery corrects deformity, reduces cartilage
80
. However, the main problems are the fixed plate which damage, and relieves pain. Osteotomy can be applied on the
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tibia when the deformity occurs on the tibia or the joint cor- arthroplasty. Knee arthroplasty is at a high risk of postopera-
onal surface tilt is less than 10 . Collins et al.86 mention that, tive infection. What’s worse, younger patients who have had
for small-angle deformity, proximal tibial osteotomy war- the replacement may need repeated revisional surgery after-
rants better outcomes. Owing to its large area of bone con- wards87. Osteotomy is easily operated, low-risk, and almost
tact, postoperative gap of the bone heals within 4 weeks, and all cases obtain rapid recovery after surgery, which is compa-
weight bearing function can be restored at early postopera- rable to arhroplasty. We have reviewed the advantages and
tive phase. It is notable that there is less complication com- disadvantages of different types of osteotomy around the
pared to others surgical osteotomies. knee (Table 1), and aim to provide guidance and support in
clinic. Though skepticism indicates that the long-term effect
Conclusion of osteotomy around knee joint is still uncertain, with the

O steotomy around knee joint advocates the concept of

step-up treatment. It is an effective treatment for knee
osteoarthritis and has unique advantages compared to knee
development of the upgraded equipment and advanced tech-
niques, this approach can be improved and become more
accurate, effective, and convenient.

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