(v) Osteotomy in the management of knee osteoarthritis and of ligamentous instability

SummaryTraditionally osteotomy has been used for redistribution of articular surface load in osteoarthritic knees. It was becoming a ‘lost art’ in orthopaedics due to the success of arthroplasty, and the perceived unpredictable outcomes of osteotomy. With newer techniques and improved predictability in results, osteotomy is rightly regaining popularity. In osteoarthritis the aim is to deliberately create deformity to unload diseased joint surface and load healthy articular surface. In ligament instability osteotomy is employed so that alignment is fine-tuned in favour of stability.A truly three-dimensional consideration of knee alignment is needed. Coronal alignment affects not only relative loading of medial and lateral tibio-femoral compartments, but stress on the collateral ligament complexes. The degree of tibial slope affects loading of the cruciate ligaments. Applying this knowledge allows enhanced results from complex ligament reconstruction of the knee.