Proximal tibial osteotomy 1970-1995.

Proximal tibial osteotomy (PTO) as a surgical treatment for selected cases of unicompartmental knee joint arthritis has been performed by the author since 1970. The results of the first 113 cases were reported in October, 1978, at the Iowa Orthopaedic Society meeting. The study was continued through 1995 to include a total of 279 osteotomies in 230 patients. Each operation was performed by the author using the surgical technique as described by Coventry. Postoperative rehabilitation and follow-up remained constant throughout the 25 year period. A detailed retrospective review of all clinical records was undertaken to determine the long term results of PTO, using revision to total knee replacement or death as end points. Eighty-three patients died and 19 were lost to follow-up. A questionnaire regarding pain, function, and the necessity of further surgery was sent to the remainder. Each patient was contacted and invited back for a clinical evaluation and radiographs. At an average 13 year follow-up, 116 patients (42%) had no symptoms and were considered a good result. This long-term review revealed that, with strict adherence to the surgical principles of obtaining and maintaining proper alignment, proximal tibial osteotomy for unicompartmental arthritis can result in good function and symptomatic relief for an average of ten to 14 years.