We live in a world where young people often participate in intense sporting and high-risk activities. Plus, we have ample motor vehicle accidents that involve young people. These activities often result in knee fractures.
Many orthopedic surgeons have often resorted to replacing the knee in young people without considering other options. Now there are some orthopedic surgeons who suggest that a high tibial osteotomy may be a better option compared to a knee replacement in young people who only have unicompartmental damage to the articular cartilage.
From the few studies reported so far, it appears that osteotomy, when combined with a cartilage resurfacing procedure, may prevent a knee replacement in future or delay the time for a total knee replacement for many years.
There was a time when high tibial osteotomy was a common procedure in the US but the technique has seen a gradual decline in use. On the other hand, there has been a high surge in the unilateral knee arthroplasty procedures in individuals in the third and fourth decade of life.
This trend of total knee arthroplasty at such a young age is now regarded by many orthopedic surgeons as the wrong thing to do.
The most experienced orthopedic surgeon now reserve joint replacement procedures for elderly patients who are less active in life and may never need to have their implant revised. Unfortunately, there are no high-quality randomized trials that have compared high tibial osteotomy with unilateral knee arthroplasty for unicompartmental arthritis of the knee.
The limited literature available suggests that in the short term both procedures appear to have similar complication and success rates. Thus, the chief reason for high tibial osteotomy in young people is because the implant after a total knee replacement has a much shorter life expectancy and a REDO procedure is almost always required in future.
We can consider that people now regularly live in their 80s. But because young people may potentially require two or three revision knee replacements. Each procedure increases the risk of failure.
The other major advantage of high tibial osteotomy is that it permits the individual to resume sporting activities. These are usually not possible after a total knee replacement as it may accelerate implant failure.
Osteotomy or Knee Replacement?
Young people choose knee replacement due to faster recovery (2-4 weeks), whereas with an osteotomy one may need to use crutches for 6-12 weeks.
However, with newer transplant techniques like stem cells and platelet rich plasma becoming viable options. This will provide more opportunities to salvage the joint surface and postpone knee replacement for decades. Once a knee replacement is done, none of these options are available.
So, in the end, the choice of procedure usually depends on surgeon experience and patient education. The patient usually thinks of short-term goals but the surgeon should be thinking about the long-term outcomes.
Melton, C. Should younger patients ever have knee replacement surgery, https://www.medscape.com/resource/arthroplasty.