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I'm 31-years old and already have signs of serious arthritis starting in my knee. The docs have already told me I'm not a good candidate for either the full joint replacement or the half-replacement that's out now. They've suggested a high tibial osteotomy instead. This sounds a little scary. Should I go for it?

There are some wonderful new ways to treat osteoarthritis in young, active adults. The half-knee joint replacement that you mentioned is called a unicompartmental knee arthroplasty (UKA). That works well for people with more arthritis on one side of the knee than on the other. Most often, it's the medial side of the joint (side closest to the other knee) that wears down and develops painful knee arthritis. So the surgeon just replaces that side of the joint with an implant. But what about patients like you who are too young or too early in the course of their disease (osteoarthritis) to qualify for a unicompartmental knee arthroplasty (UKA)? What can they do to stay active, participate in sports, or keep up in their jobs when their knee pain limits them? The high tibial osteotomy (HTO) may be a good alternative. In this procedure, a wedge-shaped piece of bone is removed from the upper part of the tibia (lower leg bone that forms the bottom half of the knee joint). The remaining two edges of the bone are lined up at in a position of slight valgus (angled inward). The medial collateral ligament (MCL) along the inside of the knee may be partially cut. This step is taken to decrease the amount of pressure placed on the medial side of the knee. The remaining bone is usually held together with a metal plate and several screws until healing takes place. The hole made by removing the pie-shaped piece of bone may or may not filled in with bone graft. If left alone, the body fills in the gap. When bone remodeling is complete, then the hardware can be removed (usually around one-year after the initial surgery). There aren't a lot of studies showing what happens to patients years after their HTO. There is one that was recently published comparing activity level before and after surgery. Understandably, patients' activities were curtailed before surgery due to pain and loss of motion. After surgery, they were able to resume at least at the level of activity they engaged in before the operation. They could do so with less pain and greater ease. Only about a quarter of the patients needed pain medication to engage in their desired level of sports and activities. Most patients did not increase their sports participation. The patients didn't say so directly, but the authors of the study thought perhaps the patients were more aware of the need to protect the joint so they didn't return to a high level of activity. High tibial osteotomy is considered an effective way to deal with early stages of arthritis that affect only one side of the joint. Active patients of all ages can qualify for the procedure.

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