Editorial Commentary: Lower-Leg Alignment Changes After Opening-Wedge Tibial Osteotomy: The Third Law of Motion and the Future of the Tibial Osteotomy.

Opening-wedge tibial osteotomies have an effect on the entire lower limb with resultant changes in alignment to the ankle and hip. These changes are not static given that there is a small but measurable change in the knee joint line obliquity over 5 years. Secondary compensation occurs in the ankle for the first postoperative year, with measured changes in the hip abduction angle over 5 years. These changes, along with the effects of the opening-wedge tibial osteotomy on a future arthroplasty, provide added information that must be considered when planning tibial realignment surgery for arthritis.