Introduction
Knee osteotomy surgery is a procedure that can provide significant pain relief and improved function for certain patients with knee arthritis. By realigning the knee to shift pressure away from the damaged area of cartilage, an osteotomy can offer an alternative to knee replacement, especially for younger, active patients.
During a knee osteotomy, the surgeon will make a precise cut in the shin bone (tibia) or thighbone (femur) and reposition the leg to correct bowing and shift body weight off the arthritic portion of the knee. There are a few different osteotomy techniques, but the goal is to realign the knee to delay advanced arthritis and the need for a total knee replacement.
For patients with arthritis primarily in one section of the knee, either from wear and tear over time or due to a previous injury, a knee osteotomy can reduce pain and improve alignment. By changing the mechanics of how the knee bears weight, pressure is taken off the damaged cartilage so it can heal. An osteotomy is major surgery that requires extensive recovery and rehab, but for the right patients it can add years of improved function before a knee replacement is necessary.
In this overview, we will discuss the key details of knee osteotomy surgery. We’ll cover the different techniques, reasons for getting a knee osteotomy, how to prepare for surgery, and what to expect during recovery. Read on to learn more about how osteotomy can be used to realign the knee and provide lasting relief from arthritis.
What is Knee Osteotomy Surgery?
Knee osteotomy is a surgical procedure to realign the knee and redistribute body weight. By changing the knee’s mechanics, pressure is shifted away from the portion of the knee damaged by arthritis.
During knee osteotomy surgery, the surgeon will make a precise angled cut across either the tibia (shin bone) or femur (thighbone). This allows the leg to be straightened or redirected slightly to correct bowing and alter the knee’s weight-bearing axis.
The main goals of a knee osteotomy are to:
• Relieve pain from arthritis focused on one section of the knee
• Correct malalignment and improve the positioning of the knee joint
• Delay the need for a total knee replacement
The ideal candidates for a knee osteotomy are generally younger, active individuals with early signs of arthritis. Good candidates may include:
• Adults under age 60 with arthritis damage confined to one side of the knee
• Individuals with healthy knee cartilage in some areas
• People with bow-legged (varus) or knock-kneed (valgus) alignment putting more pressure on one knee compartment
• Active patients willing to commit to extensive rehab
For selective patients with unicompartmental arthritis and good bone quality, a knee osteotomy can reduce pain and delay the progression of arthritis for potentially 10 years or longer. This helps postpone a total knee replacement.
Types of Knee Osteotomy Procedures
There are a few different types of osteotomy procedures that may be performed depending on the location of damage in the knee:
- High Tibial Osteotomy (HTO) – This is the most common type of knee osteotomy surgery. In an HTO, the surgeon makes the cut in the upper shin bone (tibia) below the knee. This helps correct bowing from arthritis on the inner knee compartment.
- There are two main HTO techniques:
- Open wedge osteotomy – A wedge of bone is opened in the tibia to realign the leg. This allows new bone to fill in the gap.
- Closed wedge osteotomy – A wedge of bone is removed from the tibia and the leg is closed to realign the knee.
- Tibial Tubercle Osteotomy – Cuts are made in the tibial tubercle, a bony prominence below the kneecap. This can help realign the patellofemoral joint.
- Distal Femoral Osteotomy – Cuts are made in the lower end of the thighbone (femur) to realign the knee from outer compartment arthritis.
- Combined Procedures – Other joint procedures may be done in combination, such as cartilage resurfacing, ligament repairs, or patellar realignment. The surgeon will determine the best osteotomy approach based on which portion of the knee is affected by arthritis. The goal is to shift pressure off that compartment to allow healing.
Reasons for Considering Knee Osteotomy
There are several reasons why a knee osteotomy may be recommended to realign the knee joint:
- Correcting Bow-Legged Alignment (Genu Varum): Bow-leggedness puts more pressure on the inner (medial) knee compartment. Osteotomy can realign the leg to shift weight to the healthier outer (lateral) compartment.
- Correcting Knock-Kneed Alignment (Genu Valgum): Knock-kneed alignment places more load on the outer knee compartment. Osteotomy shifts weight back to the healthier inner compartment.
- Offloading Damaged Cartilage: By realigning the knee, osteotomy can reduce pressure on damaged cartilage to encourage healing. This delays further arthritis progression.
- Preserving the Knee Joint: For suitable candidates, osteotomy allows the knee to remain intact for longer vs knee replacement. It can add years before joint replacement is necessary.
- Delaying Knee Replacement Surgery: An osteotomy procedure postpones the need for a partial or total knee replacement. For younger patients, this can mean delaying replacement for 10-20 years.
- Improving Activity Levels: With reduced arthritis pain and improved alignment and stability after osteotomy recovery, it may be easier to stay active with exercise and sports. For patients experiencing arthritis symptoms but hoping to keep their own knee, osteotomy can be an effective joint preservation option. The goal is maintaining an active lifestyle without a joint replacement.
Preparing for Knee Osteotomy Surgery
Proper planning and preparation are key steps in the process leading up to a knee osteotomy procedure. Here are some tips on getting ready for surgery:
- Imaging and Planning – X-rays, MRI scans, and full standing alignment x-rays will be used for surgical planning. This gives the surgeon a 3D view of the knee to calculate optimal realignment.
- Prehabilitation – Physical therapy will be prescribed 4-6 weeks before surgery to strengthen muscles and improve range of motion. This aids recovery.
- Nutrition – Adequate protein and nutrients should be consumed before surgery to optimize healing. Some supplements may also be recommended.
- Medication Changes – Anti-inflammatory medicines and any drugs affecting bone healing will likely be stopped 2 weeks before surgery under doctor supervision.
- Stop Smoking – Smoking severely impairs bone healing, so patients will be advised to quit smoking at least one month before surgery.
- Fasting – Instructions will be given on fasting overnight before the procedure to allow for anesthesia.
- What to Bring – Comfortable clothes, post-op shoes, toiletries, and any medications should be packed for the hospital stay.
- Following all preoperative directions will give patients the best chances of achieving optimal results from their knee realignment osteotomy. Thorough preparation helps lead to a smooth procedure and recovery.
Recovering from Knee Osteotomy Surgery
The recovery process after a knee osteotomy is lengthy, generally lasting 6 months or more. Here’s an overview of what to expect:
• Hospital Stay – Patients usually stay 1-3 days in the hospital with pain management, IV fluids, and monitoring of the surgical site.
• Pain Control – Medications will be prescribed for post-surgical pain, including opioids and NSAIDs. Icing also helps reduce swelling and discomfort.
• Weightbearing – Based on the osteotomy technique, patients may be nonweightbearing, touch down weightbearing, or partially weightbearing for 6-12 weeks.
• Brace Usage – A knee brace is typically worn to protect the osteotomy for around 6 weeks post-surgery. Range of motion is limited initially.
• Physical Therapy – PT starts within days of surgery to slowly improve mobility and strength. Therapeutic exercises continue for 6-12 months.
• Bone Healing – It takes about 3 months for the tibia or femur osteotomy site to fully consolidate. Activity is restricted during this time.
• Full Recovery – It typically takes a minimum of 6 months to return to normal activities, with a gradual increase in function over time. Sports may take a year.
• Success Rates – Approximately 85% of patients report substantial pain relief and improved knee function after healing from a properly performed osteotomy.
With adherence to all post-op protocols, recovery and results from a knee osteotomy can be excellent. However, the process requires an extended commitment to therapy and activity modification for the reconstructed knee.
Conclusion
Knee osteotomy surgery is a realignment procedure that can effectively redistribute knee pressure to relieve pain and delay joint degeneration. By modifying the leg’s mechanics, weight is shifted off of damaged arthritic cartilage to allow healing.
For patients experiencing arthritis symptoms concentrated in one area of the knee, and who are not yet ready for partial or total knee replacement, an osteotomy may be a good option. The surgery can help restore function and enable an active lifestyle again.
However, it’s important to have realistic expectations about the extended recovery time and rehab required after a knee osteotomy. If committed to the process, motivated patients can see excellent outcomes from this joint-preserving procedure.
Knee osteotomy surgery is highly technique dependent and outcomes vary. Finding an experienced orthopedic surgeon is key. For appropriate candidates, realigning the knee through an osteotomy offers a minimally invasive alternative to delaying knee replacement.
بدون دیدگاه