Most of the literature considers HTO as a procedure for unicompartmental involvement?
Bauer has shown that closed wedge high tibial osteotomy should be limited to varus osteoarthrosis Ahlbäck grade III without radiographic evidence of arthrosis in the lateral compartment [
2]. This has made a powerful statement that proximal tibial osteotomy could only yield a satisfactory result in varus gonarthrosis with medial compartment involvement. However, Keen and Dyreby demonstrated that the results of valgus osteotomy for treating varus gonarthrosis did not depend on the compartmental involvement, but on adequate valgus alignment. The knee with adequate valgus alignment had better clinical results than that with varus alignment, despite bi- or tricompartmental involvement [
3]. The belief in HTO as a procedure for unicompartmental involvement may be true for laterally-based closing wedge osteotomy, which has limitations in correcting and maintaining alignment. One should not extrapolate this to other types of proximal tibial osteotomy. The currently used closing wedge high tibial osteotomy cannot treat severe varus osteoarthritic knee because it cannot create and maintain valgus alignment until the osteotomy heals. Wagner et al. [
4] and Maquet [
5] showed that even in osteoarthritic knee with severe varus deformities and lateral compartmental involvement, satisfactory results could be obtained if adequate valgus alignment had been created and maintained. Neither of them used the laterally-based, closing wedge osteotomy but used their own techniques. Maquet used barrel-vault supratubercle osteotomy and Wagner used infratubercle displacement osteotomy.