Regarding osteotomy – osteotomy is a part of biologic knee replacement, particularly for young people with significant deformity.

However, as people get older (and ‘older’ means above the age of 30) they tend to want to avoid the pain, the long duration of recovery and the complication rate that osteotomy has been associated with in the past.

And so even though they might have an angular deformity of up to 7 to sometimes 8 or 9 degrees, they really want to treat the problem in their knee – the problem being the cartilage loss and pain – and they would rather do that arthroscopically with a biologic joint replacement and delay the time in which something as dramatic as an osteotomy is done.

However, we all realise that bad biomechanics can destroy good biology any day of the week. So in a severely angulated joint any biologic treatment will last longer if the angular deformity is corrected - but the angular deformity corrections traditionally have only been associated with 5-10 years of pain relief and have often complicated the subsequent artificial joint replacement. So if we are going to do an osteotomy for angular correction, we would always do it in conjunction with replacing the meniscus or grafting the articular cartilage. We would not do an osteotomy alone, and many times we would avoid doing an osteotomy and just do a cartilage replacement procedure and return the patient back to sports earlier, in order to decrease their post operative pain and also just buy them some time.