A 72-year-old obese man with bilateral knee osteoarthritis has medial compartment joint space loss, varus deformity of 8°, and intact ACL on MRI. He is a poor surgical candidate for TKR. The most appropriate joint-preserving surgical option is:
- A High tibial osteotomy (HTO) — medial opening wedge or lateral closing wedge ✓
- B Arthroscopic joint debridement and lavage
- C Unicompartmental knee replacement (UKR)
- D Tibial plateau levelling osteotomy
Explanation
High tibial osteotomy (HTO) is the ideal joint-preserving procedure for young-to-middle-aged, active patients with isolated medial compartment OA and varus deformity, as it offloads the medial compartment by overcorrecting valgus to 2–3° beyond neutral. In an obese 72-year-old who is a poor TKR candidate, HTO is the best joint-preserving option for medial compartment OA with varus, delaying or avoiding TKR. Arthroscopic lavage/debridement has been shown in randomised trials (METEOR, Moseley) to provide no benefit over sham surgery in OA. UKR is a more definitive option but requires good surgical candidacy. Tibial plateau levelling is a veterinary procedure.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.