A 58-year-old woman has medial compartment knee osteoarthritis with 12 degrees of varus and a preserved lateral compartment. She has a fixed flexion deformity of 20 degrees and knee flexion limited to 85 degrees. Which of the following is the most appropriate treatment?

• A Medial opening wedge high tibial osteotomy
• B Lateral closing wedge high tibial osteotomy
• C Arthroscopic lavage and physiotherapy
• D Total knee arthroplasty ✓

Explanation

Restricted flexion below 90 degrees and a fixed flexion deformity greater than about 10 to 15 degrees are established contraindications to high tibial osteotomy, because postoperative motion does not improve and results deteriorate markedly. Although her coronal profile would otherwise suit an osteotomy, the sagittal arc makes arthroplasty the appropriate choice. Arthroscopic lavage offers no durable benefit in established tricompartment-relevant disease with stiffness.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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