Dome-shaped proximal tibial osteotomy using percutaneous drilling for osteoarthritis of the knee

We have improved a surgical technique for proximal tibial osteotomy that involves percutaneous drillings. We performed the modified dome-shaped proximal tibial osteotomy on 44 knees in 42 patients (8 men and 34 women) with an average age of 66 years (range 50-78 years) for osteoarthritis of the knee. The mean follow-up period was 39 months (range 24-63 months). The varus angle was 4 degrees +/- 3.6 degrees (mean +/- SD) preoperatively, and the valgus angle was 12 degrees +/- 3.3 degrees postoperatively. Pain relief was obtained in all cases postoperatively. Transient pin tract infection occurred in one case, but it resolved completely following local irrigation. Intercondylar fracture of the upper fragment with no displacement was noted in two patients. They were treated with AO cancellous screw fixation, and improvement of pain was obtained in both cases. Osteotomy drill guide instruments are useful for accurately performing dome-shaped osteotomy. Our proximal tibial dome osteotomy with an external fixator allowed early motion and accurately maintained the angle of correction.