Osteotomy and Lower Extremity Realignment Procedures

This chapter presents a case scenario of a 49‐year‐old male runner with a history of bilateral partial medial meniscectomies, and worsening medial‐sided right knee pain of several months’ duration, refractory to cortisone injection, and conservative treatment. High tibial osteotomy (HTO) rand unicompartmental knee arthroplasty (UKA) are both indicated for the active, middle‐aged patient suffering medial‐sided knee osteoarthritis. The most commonly performed techniques of HTO are lateral closed‐wedge high tibial osteotomy and the medial open‐wedge high tibial osteotomy. Healing of the osteotomy site is influenced by a multitude of factors, including patient co‐morbidities, surgical technique, implant stability, and biologic factors. Optimizing patient characteristics and surgical technique remains the mainstay to ensuring optimal osteotomy site healing. Augmentation of osteotomy site healing with biologics or low‐intensity pulsed ultrasound has shown promise in short‐term studies. The chapter provides recommendations for implementing evidence‐based practice in the clinical setting.