Osteotomy of the knee is a surgical procedure used to treat knee arthritis and misalignment by cutting and reshaping the bones to relieve pain and improve function. This procedure is typically considered for younger, active patients who have knee damage confined to one side of the joint, and who wish to delay or avoid total knee replacement.

Types of Knee Osteotomy:

• High Tibial Osteotomy (HTO): Performed on the upper part of the tibia to correct a varus (bow-legged) deformity.
• Distal Femoral Osteotomy (DFO): Performed on the lower part of the femur to correct a valgus (knock-kneed) deformity.

Anatomy

• Femur (Thighbone): The upper bone of the knee joint.
• Tibia (Shinbone): The lower bone of the knee joint.
• Cartilage: Cushions the bones and allows smooth movement.
• Ligaments: Provide stability and support.
• Menisci: C-shaped cartilage pieces that act as shock absorbers between the femur and tibia.

Indications for Knee Osteotomy

• Unilateral Knee Arthritis: Arthritis affecting only one compartment of the knee (medial or lateral).
• Knee Malalignment: Bow-legged or knock-kneed deformity causing uneven load distribution.
• Younger Age: Typically recommended for patients under 60 who are active and wish to maintain their activity level.
• Pain and Functional Limitation: Significant pain and limited function not relieved by conservative treatments.

Pre-Operative Evaluation

Medical History and Physical Examination:

• Assessment of overall health, knee function, and alignment.
• Evaluation of symptoms and activity level.

Imaging Tests:

• X-rays: Assess alignment, arthritis severity, and bone structure.
• MRI or CT Scan: Evaluate cartilage, menisci, and other soft tissues.

Lab Tests:

• Blood tests to assess general health and rule out infection.

Procedure

Anesthesia:

• General anesthesia or regional anesthesia (spinal or epidural) to numb the lower body.

Incision:

• A surgical cut is made over the knee to access the bone.

Bone Cutting and Realignment:

• The surgeon cuts the tibia or femur, depending on the type of osteotomy, and realigns it to redistribute the weight across the knee joint.

Fixation:

• The bones are stabilized using metal plates, screws, or staples.

Closure:

• The incision is closed with sutures or staples, and a sterile bandage is applied.

Recovery & Rehabilitation

Immediate Postoperative Care:

• Hospital Stay: Typically lasts 1-3 days.
• Pain Management: Medications to control pain and inflammation.
• Blood Clot Prevention: Blood thinners and compression devices to prevent deep vein thrombosis (DVT).
• Initial Weight Bearing: Partial or non-weight bearing on the operated leg, using crutches or a walker.

Long-Term Rehabilitation:

• Physical Therapy: Gradual exercises to restore strength, flexibility, and range of motion. Focus on improving stability and preventing stiffness.
• Weight Bearing: Gradual increase in weight-bearing activities as directed by the surgeon.
• Activity Modification: Avoid high-impact activities until fully healed, typically within 6-12 months.

Potential Complications:

• Infection: Risk of infection at the surgical site.
• Blood Clots: Risk of DVT or pulmonary embolism.
• Nonunion or Malunion: Failure of the bone to heal correctly.
• Nerve or Blood Vessel Injury: Potential for injury during surgery.
• Residual Pain: Ongoing pain despite the procedure.
• Hardware Problems: Issues with the metal plates or screws used for fixation.

Outcomes and Prognosis:

• Pain Relief: Significant reduction in pain for most patients.
• Improved Function: Enhanced ability to perform daily activities and maintain an active lifestyle.
• Delay in Knee Replacement: Many patients can delay or avoid total knee replacement for several years.

FAQ’s

How long does the surgery take?
The procedure typically lasts 1-2 hours, but the total time in the operating room may be longer due to preparation and anesthesia.

When can I return to normal activities?
Most patients can return to low-impact activities within 3-6 months, but high-impact activities should be avoided until fully healed, usually within 6-12 months.

Will I need crutches or a walker after surgery?
Yes, initially, you will need crutches or a walker to offload the operated leg and aid in mobility.

How long will it take for the bone to heal?
Bone healing typically takes about 6-12 weeks, but full recovery, including return to normal activities, may take several months.

Are there alternatives to knee osteotomy?
Alternatives include conservative treatments like medications, physical therapy, and injections, or other surgical options like partial or total knee replacement.