It looks like I’m wearing down the inside edge of my knee. At 44, I’m too young for a joint replacement. The surgeon explained that an osteotomy might work well for me. Are there any reasons why I shouldn’t do this?

Sometimes (like in your case) osteoarthritis of the knee only affects one side of the joint. When that happens, it’s called unicompartmental knee arthritis. Although either side of the joint can be involved, the medial joint (side closest to the other knee) is affected most often.

Surgical treatment for this problem could be with a tibial osteotomy. During this procedure, the surgeon removes a pie- or wedge-shaped piece of bone. The osteotomy may be an opening wedge tibial osteotomy or a closing wedge.

The difference is in the direction of the pie-shape. Open wedge is used to create distance between the two sides of the bone. The result is to shift the weight away from the side of the osteotomy. Closed wedge collapses the two edges of bone, thus shifting the weight toward the side of the osteotomy.

There are pros and cons with either technique. The goal is to shift the mechanical weight-bearing load away from the medial joint line and move the weight distribution more toward the middle of the joint. The intended result is to decrease joint pain and improve function.

The technique has been improved over the years, making it possible to preserve bone in younger, active adults. Later, you might be a good candidate for a unicompartmental knee replacement. Loss of correction and delayed bone healing are two concerns after tibial osteotomy surgery. You’ll want to ask your surgeon about your chances for any complications as well as what to expect in terms of recovery of motion and function.