Knee Osteotomy

What is knee osteotomy?

Osteotomy is an appropriate surgical option in selected cases of arthritis affecting one side of the knee only. The purpose of osteotomy is to transfer the load within the knee to an uninvolved joint surface. Osteotomy is most commonly performed for patients where the weight bearing surfaces of the knee joint become worn away on one side. The affected side of the joint is no longer smooth and free running and this leads to stiffness and pain. It should be stressed that this surgery is designed to allow patients to walk without discomfort, not to return them to sporting activities. If adequate correction is achieved, the success rate of high tibial osteotomyt is 90% at the 5 years and 80% at 10 years. Those patients who fail to achieve such long-term relief usually obtain at least a few years of relief and then often progress to joint replacement.

Osteotomy is strongly recommended for the middle-aged patient with osteoarthritis.  Patients approaching the age of 60 yrs should consider continuing with conservatives measures for as long as possible so that when complete deterioration of the joint has occurred, joint replacement may be performed.

How can a knee osteotomy help?

By realigning the leg, the body weight is transferred onto the undamaged part of the knee.  This will lead to decreased pain in the joint with the goal of allowing a return to desired activities.

 

What sort of anaesthetic is used?

Knee osteotomy can be performed under regional, or general anesthesia. Regional anesthesia numbs below your waist, and general anesthesia puts to sleep. The anesthetist will help determine which is the most suitable for you.  Generally this procedure requires an overnight stay in hospital.

What should I expect after the knee osteotomy?

Most patients experience only mild discomfort when they wake up after a knee osteotomy.

Wounds will be dressed with waterproof dressings under the outer bandage. The outer bandage may be removed 24hrs after surgery.  The smaller dressing is to remain intact for 7-10 days.

Bearing Weight After most osteotomy surgeries, crutches will be required for walking.  The osteotome is held with a strong plate and screws that will keep the osteotomy in place.  Gradual increase in weight bearing on the leg as discomfort subsides and strength is regained in the knee.

Exercises to Strengthen The Knee It is important to exercise the knee regularly for several weeks following surgery to strengthen the muscles of the leg and knee. A physiotherapist may help with an exercise program.

How Long will it take to recover?

Recovery after knee osteotomy takes up to 18 months.  This is the time it takes to regain muscle strength and see the full benefit of the surgery.  Patients are usually able to walk without crutches by 6-12 weeks and the osteotomy site is usually healed enough by 6 months to allow running. Often the plate used to hold the osteotomy needs to be removed at 1yr after the surgery.

Is physiotherapy required after knee osteotomy?

Yes.  Physiotherapy is commenced immediately post operatively. A physiotherapist will supervise muscle contractions, walking and weight bearing. Physiotherapy will continue on a daily basis following surgery until the dressings are removed 7-10 days following surgery. Sedentary and office workers may return to work approximately 2-3 days following surgery.

What are the risks?

Knee osteotomy is a very safe procedure. The most common side effect is temporary discomfort or slight bruising.

Injury to the peroneal nerve can occur following high tibial osteotomy. This may result in sensory loss or muscle impairment. Most patients recover without any permanent functional disability. Injury to the blood vessels around the knee during surgery is a very rare complication (less than 1%). Delayed or non-union of the osteotomy site may occur in 2 to 4% of cases.  Other potential problems include postoperative stiffness, pain and wound problems.

As with all operations if at any stage anything seems amiss it is better to call up for advice rather than wait and worry. A fever, or redness or swelling around the line of the wound, an unexplained increase in pain should all be brought to the attention of the surgeon.