By Christin Melton
The Treatment of Choice for Younger Patients
Jack M. Bert, MD, an orthopedic surgeon at Minnesota Bone & Joint Specialists in Woodbury, Minnesota, has an important message for his colleagues: Always choose a high tibial osteotomy (HTO) over a knee replacement procedure for younger patients who have unicompartmental articular cartilage damage. He made his case in a presentation at Orthopedics Today Hawaii 2015 and elaborates on this perspective in an interview with Medscape.
“Osteotomy, particularly when combined with a cartilage resurfacing procedure, may prevent some patients from ever requiring a knee replacement. It will definitely delay the need for a total knee replacement for many years and hopefully salvage the joint long enough for technology to catch up,” Dr Bert says. 
Although HTO used to be common practice in the United States,[1] the annual growth rate in HTO declined 3.9% between 2007 and 2011.[2] “Meanwhile, there has been an upsurge in unilateral knee arthroplasty (UKA) for patients in their 30s and 40s, which is absolutely the wrong thing to do,” he says.
Dr Bert says he typically reserves joint replacement procedures for “older patients who are less active and may never need to have their implant revised.” Few high-quality randomized, controlled trials have directly compared outcomes with UKA vs HTO for unicompartmental osteoarthritis of the knee, but literature reviews suggest that the procedures have similar rates.