De rol van knie osteotomie bij mediale gonartrose in de hedendaagse orthopedische praktijk

The role of knee osteotomy in medial gonarthrosis in contemporary orthopedic practice Osteoarthritis is a debilitating condition characterized by recurrent joint pain that, according to recent figures, affects approximately 500 million people worldwide. Gonarthrosis is the most common type of this condition. In many cases, it involves isolated medial gonarthrosis. This degenerative disease in the human knee is characterized by cartilage wear and meniscus degeneration, often combined with varusmalalignment at the lower limb. Besides conservative treatment in the form of medication, exercise therapy, and injections, there are two surgical treatment options for severe cases: the unicompartmental medial knee prosthesis (mUKP) and the valgus-producing high tibial osteotomy (HTO). Unlike the very frequently performed joint replacement procedures, knee osteotomy is a joint-preserving surgery aiming to relieve the diseased medial compartment through axis correction of the deformed limb without replacing it. A HTO is especially suitable for patients with debilitating medial gonarthrosis where there is no bone-on-bone contact, as it offers a joint-preserving approach by redistributing the load. On the other hand, a UKA is indicated for patients with severe pain and completely worn-out cartilage in the medial femorotibial compartment. Despite a very extensive historical background, knee osteotomy has been relegated to the background in contemporary orthopedic practice due to the significant rise of prosthetic surgery. For unclear reasons, knee osteotomy is often unjustly associated with high postoperative pain levels and long recovery times. However, recent studies on modern osteotomy techniques position HTO as a highly valuable, joint-preserving treatment option for isolated medial gonarthrosis that drastically improves patients' function and simultaneously reduces the need for more expensive prosthetic surgery. In times of financial constraints on healthcare budgets, modern high tibial osteotomy can be a particularly valuable treatment for patients experiencing debilitating pain, with a varusmalalignment, but who have not yet developed terminal osteoarthritis.