Arthroscopic lavage - which means either large or small volume saline irrigation of the knee. It is often associated with debridement and loose body removal of the joint.There is a belief that lavage removes toxics enzymes that may reduce the pain and inflammation of the joint.

It is a bone-removal procedure that can help realign the deformity there by changing the weight bearing axis in selected patients

High tibial osteotomy is a well-established procedure for the treatment of unicompartmental osteoarthritis of the knee.

Varus or valgus deformities are fairly common and cause an abnormal distribution of the weight bearing stresses within the joint. The most common deformity in patients with osteoarthritis of the knee is a varus position, which causes stresses to be concentrated medially, accelerating degenerative changes in the medial part of the joint ; if the deformity is one of valgus position, changes are accelerated in the lateral part. The biomechanical rationale for proximal tibial osteotomy in patients with unicompartmental osteoarthritis of the knee is "unloading" of the involved joint compartment by correcting the malalignment and redistributing the stresses on the knee joint.

The indications for proximal tibial osteotomy are

1. pain and disability resulting from osteoarthritis that significantly interfere with        high-demand employment or recreation,

2. evidence on weight bearing radiographs of degenerative arthritis that is        confined to one compartment with a corresponding varus or valgus deformity,

Knee osteotomy is used when you have early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting your weight off of the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in your arthritic knee.

HTO is indicated on the patient who is 40 to 60 years ofage, who still is active, who does not have a sensitive joint, who has knee pain, and who clearly is too young and active for either uni or total knee arthroplasty.

Advantages and Disadvantages

Knee osteotomy has three goals:

• To transfer weight from the arthritic part of the knee to a healthier area
• To correct poor knee alignment
• To prolong the life span of the knee joint

ADVANTAGES

1. By preserving your own knee anatomy, a successful osteotomy may delay the       need for a joint replacement for several years.

2. Another advantage is that there are no restrictions on physical activities after an     osteotomy - you will be able to comfortably participate in your favorite activities,       even high impact exercise.

3. Osteotomy can relieve pain and delay the progression of arthritis in the knee.

4. It can allow a younger patient to lead a more active lifestyle for many years.

Even though many patients will ultimately require a total knee replacement, an osteotomy can be an effective way to buy time until a replacement is required.

The body weight applies on the knee through the femoro-tibial mechanical axis of the limb, it passes across the center of the knee. In case of VARUS deformation, the mechanical axis is deviated medialy increasing load compression forces on the medial compartment of the knee, and thus a cartilage lesion leading to medial arthrosis.

Total knee replacement

severely degenerated joints are best treated by total/partial replacement with an artificial joint (arthroplasty).