Osteotomy
What is involved?
Knee osteotomy involves realigning the axis of the leg to take pressure off part of the knee joint that is worn or damaged. The thigh bone or shin bone is carefully divided in and fixed in a new position, with specialised plates and screws. This means that a previously bowed or knock-kneed leg can be realigned and straightened to allow the body weight to be evenly distributed through the knee joint, relieving pressure on damaged tissue. This helps preserve the knee joint, which improves both the symptoms and reduces the onset of arthritis in the knee, postponing the need for replacement surgery.
Specialised x-rays and scans allow precise planning of the surgery, and we will often use bespoke computer-designed and 3D printed cutting guides to correct the abnormalities in your knee for the greatest accuracy.
Why might I need an Osteotomy?
An osteotomy is normally carried out when you have wear and tear, or arthritis in one section of your knee joint. The procedure is more effective in people who have earlier degenerative change than fully established bone-on-bone arthritis. The procedure is normally carried out in people who have malalignment of their legs, which has lead to to certain patterns of arthritis.
1) Bow-legged deformity – if you have varus (bow-legged) knees, more of your body weight is transferred through the inner side (medial) part of your knee joint. An osteotomy in the proximal part of your tibia (shin bone) to open a wedge and realign the knee, will relieve pressure on this section of the knee.
2) Knock-kneed – if you have valgus (knock-kneed) legs, you may develop arthritis on the outer side (lateral) part of your knee. In this situation, a distal femoral osteotomy, where the bottom part of your thigh bone is realigned, will straighten the leg and put more weight through the less damaged medial part of your knee.
What happens after surgery?
Following surgery you will be managed initially by our expert physiotherapy team on the ward. They will provide you with appropriate analgesia and your knee will be wrapped in a state-of-the-art cooling device to reduce swelling and pain. The method of osteotomy used is such that we will encourage you to bear weight as much as is comfortable, immediately after surgery. You will normally require the aid of crutches for a few weeks. Once you have recovered from the anaesthetic, we will be able to discharge you. This is normally on the same day, or the day after surgery. Physiotherapists will then visit you at home to help regain your range movement and strength in your knee, and you will be reviewed by your surgeon at two and six weeks after surgery, to ensure you are progressing as we would hope.
Recovery milestones
Weeks 1 to 2
Over this period of time appropriate analgesia and ice treatment is used to reduce the pain and swelling in your knee, and allow you to regain a full range of movement. With the use of crutches, you will be bearing weight on the knee, as pain allows.
Weeks 2 to 6
The osteotomy within the bone and the small gap in the bone that results from this will heal during this time, and solid new bone will form across the gap. At approximately six weeks an x-ray will be taken to confirm that the bone is healing and you can gradually wean yourself off crutches.
Weeks 6 to 12
You should begin to walk more normally, without a limp, and begin to return to normal activities.
Weeks 12 onwards
We expect you to return to full activity at a time and rate appropriate to your particular case. One of the benefits of an osteotomy is that you should be able to return to high-impact sporting actives that some patients following knee replacement surgery can find difficult.
Frequently asked questions
What are the advantages of knee osteotomy over knee replacement?
Osteotomy is appropriate in cases where arthritis has not affected the entire knee joint, and removal of undamaged tissue would be required to perform an entire knee replacement. Osteotomies are normally more beneficial in younger, more active patients who want to get back to high-impact activities. Osteotomy can reduce any pain in your knee, without the need for a complete replacement, and give you improved range of movement and better long-term function. Osteotomy can delay the need for knee replacement surgery or, in some cases, avoid the need for replacement surgery all together.
How long does it take to recover from knee osteotomies?
Most people are able to bear their own weight within 24 hours of surgery, but full rehabilitation to walking without crutches normally takes approximately 12 weeks.
When will I be able to return to work?
Most people will be able to return to work within six weeks of surgery. People with more manual jobs may require 12 weeks off work.
When can I return to sport?
One of the benefits of a knee osteotomy is it allows you to return to a higher level of sport and activity than you might consider feasible following a full knee replacement. You can return to competitive sport between 6 to 12 months after surgery.
Will the plate and screws have to be removed?
Following healing of the osteotomy, dependent on your particular circumstances, we may recommended the plate and screws are removed to avoid complications should a knee replacement be required at a later stage.
