Q: My 50 years wife is suffering from osteoarthritis in her both knees. The doctor has advised her to undergo a knee surgery. Which knee surgery is advisable - osteotomy or knee replacement?

A:All these surgeries have their own set of indications. If it is an advanced osteoarthritis, joint replacement may be advisable, particularly to protect the other knee from further damage. It is a definitive procedure with 15-20 years life if done by an experienced surgeon from a reliable centre.

High tibial osteotomy (HTO) will not address arthritis but will give temporary relief by correcting the alignment of the knee. Total knee replacement (TKR) will usually be required after about 6-8 years. Previous HTO makes TKR a challenging surgery. Arthroscopy will actually help to buy some time before any of these other surgeries are planned. Combining it with HTO may improve the chances of pain relief, however unpredictability of outcome still persists.