Knee osteotomy is surgery that removes a part of the bone of the joint of either the bottom of the femur (upper leg bone) or the top of the tibia (lower leg bone) to increase the stability of the knee. Osteotomy redistributes the weight-bearing force on the knee by cutting a wedge of bone away to reposition the knee. The angle of deformity in the knee dictates whether the surgery is to correct a knee that angles inward, known as a varus procedure, or one that angles outward, called a valgus procedure. Varus osteotomy involves the medial (inner) section of the knee at the top of the tibia. Valgus osteotomy involves the lateral (outer) compartment of the knee by shaping the bottom of the femur.
Osteotomy surgery changes the alignment of the knee so that the weight-bearing part of the knee is shifted off diseased or deformed cartilage to healthier tissue in order to relieve pain and increase knee stability. Osteotomy is effective for patients with arthritis in one compartment of the knee. The medial compartment is on the inner side of the knee. The lateral compartment is on the outer side of the knee. The primary uses of osteotomy occur as treatment for:
According to Healthy People 2000, Final Review, published by the Centers for Disease Control and Prevention, the various forms of arthritis "the leading cause of disability in the United States" affect more than 15% of the total U.S. population (43 million persons) and more than 20% of the adult population. Osteoarthritis (OA) is the most common form of knee arthritis and involves a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people. The most common source of ACL injury is skiing. Approximately 250,000 people sustain a torn or ruptured ACL in the United States each year. Research indicates that ACL injuries are on the rise in the United States due to the increase in sport activity.
Osteotomy is performed as open surgery to the knee assisted by pre-operative arthropscopic diagnostic techniques. Surgery takes place on the tibia end or the femoral end at the knee according to whether the malalignment to be corrected is varus, or inward leaning, or valgus, outward leaning. The surgery involves the gaping or wedging of a piece of bone and its removal to change the pressure points of weight-bearing activity. The cut surfaces of the bone are held together with two staples, or a plate and screws. Other devices may be used, especially in tibial osteotomy where a fracture is involved. After surgery, a small plastic suction drain is left in the wound during recovery and early postoperative hospitalization.
Severe or chronic pain and/or knee instability brings the patient to an orthopedic physician. From there, the decision is made for surgery or for rehabilitation. Patients will undergo an examination and history with their physician. Once rehabilitation or other treatments are ruled out and surgery is indicated, the physician must assess for three factors: pain, instability, and knee alignment. Osteotomy is indicated if malalignment is a factor. Debridement , or the shaving of cartilage on the articulate femur or tibia, can usually resolve pain with instability problems. It must be determined whether the instability is related to malalignment and not to other sources such as ACL injury. Since the goal of osteotomy is to shift weight from a symptomatic cartilage to an unsymptomatic area to relieve both an instability and pain due to excessive contact, alignment of the knee is assessed for pressure distribution along the mechanical axis and the loading axis. This requires an analysis of gait pattern, range of motion, localized areas of pain, and neurological factors, as well as other technical tests for anterior instability. A diagnostic arthroscopy—examination of the knee joint with a long tube attached to a video camera—is usually indicated before all knee osteotomies. Cartilage surfaces are examined for degenerative or late-stage arthritis. Magnetic resonance imaging (MRI) is useful in evaluating any intra-articular pathology such as bone chips, padding tears, or injuries to ligaments.
After surgery, patients are placed in a hinged brace. Toe-touching is the only weight-bearing activity allowed for four weeks in order to allow the osteotomy to hold its place. Continuous passive motion is begun immediately after surgery and physical therapy is used to establish full range of motion, muscle strengthening, and gait training. After four weeks, patients can begin weight-bearing movement. The brace is worn for eight weeks or until the surgery site is healed and stable. X rays are performed at intervals of two weeks and eight weeks after surgery.
The usual general surgical risks of thrombosis and heart attack are possible in this open surgery. Osteotomy surgery itself involves some risk of infection or injury during the procedure. Combined surgery for ACL and osteotomy has higher morbidity rates.
Varus malalignment correction with osteotomy through the high tibia (HTO) is a proven and satisfactory operation. Success rates are high when the patient has a small angle deformity (<10°). Knees with more severe deformity have less satisfactory results. Tibial osteotomy for the less common valgus deformity is less satisfactory. Research indicates that only a few individuals are able to return to their previous level of high sports activity after a knee osteotomy, whether done with an ACL repair or not. However, more than half of patients in one study were able to return to leisure sports activities. Reports also indicate that those individuals who had osteotomy without ACL reconstruction had no differences in results with respect to measures of stability. It may take up to a year for the knee to be fully aligned and adapted to its new position after surgery. Most patients, more than 50%, gain stability and are able to walk further than they could walk before osteotomy. However, according to one report, 13% of patients had severe pain or needed a total knee replacement after five years. In one European review, the results were better. Osteoarthritis was arrested in 105 cases (69%), with 47 cases showing deterioration. The main factors associated with further deterioration were insufficient correction and persistence of malalignment.
Morbidity rates include bleeding, inflammation of joint tissues, nerve damage, and infection.
For those individuals suffering from osteoarthritis, muscle-strengthening exercise , weight loss, and rehabilitation can be helpful in relieving pain and gaining stability. Anti-inflammatory medications can also be effective in helping pain and stability. For severe varus or valgus deformities, osteotomy or knee replacement may be indicated. For those with severe ACL injury with secondary trauma to knee cartilage, complete knee replacement may be suggested.
Ruddy, Shaun, et al., eds. Ruddy: Kelly's Textbook of Rheumatology, 6th Edition. Philadelphia: WB Saunders Publishing, 2001.
Alleyne, K. R., and M. T. Galloway. "Management of Osteochrondral Injuries of the Knee." Clinics in Sports Medicine 20, No. 2 (April 2001).
Shubin Stein, B. E., R. J. William, and T. L. Wickiewicz. "Arthritis and Osteotomies in Anterior Cruciate Ligament Reconstruction." Orthopedic Clinics of North America 34, no. 1 (January 2003).
American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Rd., Suite 200, Rosemont, IL 60018. (847) 823-7186. (800) 346-2267, Fax (847) 823-8125. http://www.aaos.org/ .
Arthritis Foundation. P.O. Box 7669, Atlanta, GA 30357-0669. (800) 283-7800. http://www.arthritis.org .
National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (301) 495-4484, Toll-Free (877) 226-4267. Fax: (301) 718-6366. TTY: (301) 565-2966. http://www.nih.gov/niams .
Nancy McKenzie, PhD
An orthropedic surgeon speciliazing in knee reconstruction surgery performs the operation. Surgery takes place in a general hospital.
Thank you.
Looking forward to hearing back,
Cherie Krol
My surgery involved cutting a portion of the bone (not sure exactly from where and how big) and fused it below my knee cap with a couple of screws. well, that's how it feels now that bruising and swelling start to subside. Intially, I had this huge swelling and bruising all over my leg down to my inner ankle. I did apply ice for about 15 minutes once a day for the first 2 weeks, perhaps I should have done more.
I came out of the operating theatre with a straight splint or brace on my leg which I'm still wearing 24/7 apart from showers. I have not started physiotherapy yet and I dread the thought of doing active movement on my knee like bending. Right now, I can feel my knee's very stiff. Since the numbness on the knee began to subside, I get this kind of 'undesirable sensation' below my knee which is where the bone and the screws were implanted. I get this feeling after sitting down with my leg down straight in an angle on the floor or lying down. It is still numb on the side of the wound and lightly on the knee as I do give it a regular light massage with a lotion after shower.
My left knee is still comparably larger (still swolen) than the right knee, the numbness is still present on the outer side of the wound site below the knee, and the wound has healed neatly after 4 weeks. With this in mind, when is it advisable to start physiotherapy? I walk around the house without crutches when not tired but still limping. I still have to get my hubby to carry my leg in the front car to be able to get in. I really am missing my freedom!! Now I can truly understand the limitations of those who are physically impaired and I have high regard for their courage and determination to live life in the best of their ability.
With this in mind, my impefection comes from a congenital loose knee caps. I have always been falling down a lot as a young active teenager. In every games that I was in, I used to fall down and get taunted. Until I was in my early 20's when I was finally directed to see an orthopaedic surgeon. I then had my right knee reconstructed, 18 years ago. My left knee should have been done a long time ago but life has been so full on until my left knee started giving way a lot and knew then that I needed to have it done.
gemma
Can some one please advise me on the correct way to start my rehab as I am not seeing a physio for 3 weeks and I think having a head start on the correct exercises/moves will make physio a bit easier.
Thanks for reading this any reply will be very much appreciated
I understand the surgery is painful. I have had an acl replacement in one knee and had to have my patellic ligament moved on the other leg. I didn't have much pain with either surgery. Is this that bad?
Could anyone suggest exercises that would be good to do before surgery? I have recently lost some weight but could stand to lose more.
Also, The removal of the hardware on the right leg has not been a problem. Yes, I had some swelling on the right leg, not much, but I have been using my right leg as normal. The bone growth to fill in the holes will take about 6 weeks, so I have to take it easy too on the right. That won't be a problem as the left leg will keep me inactive. Just wanted you to know that it really was not a problem.
When and how you return to work depends on the type of job you have. I have a desk job and physically can return to work after 4 weeks (that's what I did last time). Right now, I can work from home. I will be getting on line after 2 weeks (may be not full time - depends on what is going on.)
BTW, I already see the difference on my left leg. Can't wait to see me walk in front of a mirror, wear the straight leg pants, or that above the knee skirt dress! It makes me sad to think how long I waited and how it impacted me. I will not dwell on this any further. I will enjoy the rest of me and the future!
I'm the same Wanda from an earlier post. I am going in again on Dec 2nd to remove the metal plate. It will be an in and out 30 minute surgery.
There are no words to describe what this corrective surgery has meant to me! Oh how I wish I would have done this 10, 20, 30, years ago!
Here's my story: I live in France, and since 2004, I am struggling to get an osteotomy.Every doctor that I saw was categoric: it is an surgery that thay offer only when you are 50 years old or more, and/or if you have a lot of pain and are almost invalid.
Now you have given me hope; I am looking forward to get that treatment in the UK and I would like to know whether some of you are from there.
I am aiming at an hospital in London, and it would be great to know the experience of someone that has been healed in London.
I am 28 years old and the situation of my legs have evolved; they are more x-shaped now, and I feel all sorts of uncomfortable sensations in the outside areas.
Good luck to everyone. It has been a terrible thing to live with - no shorts, short dresses, etc. But I hope to change all that soon!
I am in my eigth day following a HTO and micro fracture procedure to the left knee to ease pain for arthritus and wear to the inside og the knee. I am an active 41 year old with plenty of sporting background.
I am reading that many people have a brace on their leg but I have left hospital 1 day later with not such device on my leg and a leaflet outling some excersise for a TKR on them with how often to perform each excersie. The frustrating thing for me is what of the excersise should I be able to perform at this stage and should the pain be keeping me awake everynight to the point I cant get any sleep. Swelling has reduced well but the shin bone I can bearly touch with my finger tip. Is this an expected level of pain and is this procedure performed where no brace is worn following the operation?
Regards
Rob
The day of surgery, I reported to the hospital at 5:30am. Once my named was called, I went to an area where I got undressed, put on the fun slipper socks and hopped into the "not so comfortable" hospital bed. After the IV was in place, I spoke with the anesthesiologist. He described to me that he would be performing a nerve block in my thigh that would numb my entire right leg. At this point, with my nerves slightly on edge, I was given a relaxation medication. From that point forward it was smooth sailing.
Following surgery, my leg was wrapped and placed in an immobilizing brace. I spent 2 nights and 3 days in the hospital before my doctor felt comfortable enough to let me go home. I did, however, leave the hospital with the drain still in my leg (Yuck!). This was removed the following day at my doctors office (Double Yuck!). During my appointment, I was able to look at my knee for the first time since having the surgery and boy, was I in for a surprise! What I thought would be stitches holding my leg together ended up being staples...yeah...17 of them to be exact! I also noticed a lot of swelling and bruising down my leg and around my ankle and foot. The doctor ordered my first x-ray at this time. I was also instructed to wear the immobilizing brace and to use crutches at all times, only allowing my toe to touch the floor.
Ten days following my first appointment, I returned to the doctors office to have my staples removed. Okay, so maybe I physced myself out a little but I couldn't help but think the only way to get these things out was with a staple remover! Never having staples in my body before, I went into the room holding my breath. Okay, so 10 seconds later and I realized it was a piece of cake, partly contributed to the fact that a good portion of my leg was... and is... still numb. The doctor came in afterwards to check on my progress. With things looking good, I left still wearing the immobilizing brace and using crutches.
So here I am. In another week I will go back for another x-ray and possibly an upgrade to a bendable brace. Of all the surgeries I have had, this one by far takes the cake! I must say that patience is needed for a procedure such as this one. The recovery time is quite lengthy. I have managed to hobble around my apartment but aside from that, I can't do much of anything on my own. The pain I had initially experienced about 1 week into post surgery was much more uncomfortable than what I feel now. At this point, however, I am still taking pain medication. I am hoping to begin physical therapy in the near future and will most likely return to work after being out for 4 weeks. Not an ideal vacation but one worth having if it means I will live with much less pain. I plan on having the same procedure done to my left knee after my right knee is completely healed.
Can anyone tell me how soon after having one surgery can I have the second? 6 months, 1 year?...
I had a HTO procedure 10 years ago in an attempt to stave off my requirement for a knee prosthesis. My initial problems of osteo-arthritis were caused by a full medial menisectomy on my left knee 32 years ago (I was 20). Over the years my leg had become slightly bowed which, because of the weight geometry made things worse.
My outcome was far better than expected. Since that procedure I have gained sailing, flying and SCUBA diving qualifications. The cold water, dry suit diving involves the carrying of heavy equipment. The helicopter flying is a trial on any fit knees, operating the anti-torgue pedals.
I regularly play badminton and football.
if I'm honest, I would have to say that I'm probably now, beginning to feel slight, constant pain in my knee, finally.
But it should be said that I benefited from an additional 10 years of full active living, thanks to this procedure.
Yes, the HTO recovery was long and painful. I contracted cellulitis which set my recovery back a bit. Yes, you need good familiy and social support. Yes, you need a sympathetic employer.
Do I consider the whole process worth it ? - ABSOLUTELY !!!
Really I wouldn't let all of that scare you off from the procedure. Mine was probably one of the tougher osteotomies to go through. Pain will be an issue for a while. I was non-weight bearing for six weeks, but as soon as I got cleared to put weight down on the leg, the healing sped up, and the pain dropped off. At three months I can fully bear weight on the leg, but usually get around on one crutch. It's still too soon to say if the surgery fixed the pain I was having before, but it's amazing how straight the leg looks now.
I was told the plate was meant to stay in forever, as long as there were no complications with it.
I keep hearing about the procedure but i want to know where and cant find any information on this,please help me and tell me where
Just a quick history... I had the following done
Dec 6, 2009 Right Knee
Dec 7, 2010 Left Knee and Right plate removal
Dec 2, 2011 Left Knee plate removal
I waited a year in between all 3. In hindsight, 6 months between each would have safe, however I took into consideration the amount of care I was asking of my husband who was nursing me through each one. To be honest, it was only the first and second week where I needed the extra TLC. The rest of the 6 week recovery I was pretty much on my own. Bottom line, it was my decision to wait a year.
I cannot explain why the plates caused minor pain depending on what I was doing or why the skin was sensitive to the touch... almost like a rash burn sensation. What I can tell you is that removing the plates have brought me pretty much to 100%. Before I couldn't sleep on my side curled up like a baby with one knee on top of the other. Even after having the last plate removed, it still took about 9 months before I absolutely felt nothing! I don't mean to scare anyone, the pain is similar to pressing on a bruise. All you do is reposition so as to not put direct pressure. A pillow works wonders!
This will probably be my last post as I feel like I am done. People are shocked at what I went thru to get it done. I've never thought of it as major surgery. My view is that it really wasn't that bad, only the 1-2 weeks immediately after surgery. I tell everyone it was "elective, corrective, and preventive" surgery.
Good luck to those thinking about doing it. My advice is don't wait...the sooner, the better. You will be much happier. I thank the man up in the sky everyday I walk in my closet to figure out what to wear - no more hiding my knocked knees! I love watching myself walk toward a door with reflective glass. It's always a feeling of "wow, look at that - straight legs!"
Thank you again so much!
My surgery was done at a hospital in Arizona that specializes in "orthopedics". One comment that my Dr. made was that when the misalignment is genetic... it is genetic and outgrowing is not gona happen. In my case, it was genetic as other members of the family have the same problem. He did tell me that he had done the surgery on a middle school aged girl early in the summer so that she was ready to go back to school in Aug/Sept. Hers was genetic as well. There are pictures of me as a child and clearly you can see I was knock kneed. My dad's side of the family was knock kneed. My mom's side of the family were bowl legged.
The 3-4 inch scares have gotten better over time. But from my perspective, they are a small price to pay. I have not had any problems. I can bend, run, walk, dance, same as before. What I do not do is anything that is pounding or impactful such as long distance running. Walking 4-13 miles is the most I have done and not had a problem.
In regards to the surgery some facts people need to understand is that.
1. The procedure is very painful so be prepaired for that. Unfortunately for me pain meds like endone does not really work for me as i have a high tolerance for morphine which is the main med prescribed.
2. Having a fever is very common especially if there a large amount of bleeding during the procedure. I had a fever for 6 days straight and i stayed in hospital for those six days as i thought the wound had become infected. That was not the cause though its just common to have a fever after such a large procedure.
3. Be prepared to wear the brace as bending is not allowed past 60 degrees for the first couple of weeks. This is worn for 6 weeks.
4. Your leg will become bowed looking, its abit hard to accept at first day at the end of the day most people cant really tell until u point it out.
As im only still early on in my journey i cant comment much more but will check back in and add more as i go and try and answer any questioned asked.
hard due to the pain in my left knee, I did some tests and MRI and the result came out like this, right knee is kinda ok with ACL problem which can be fixed the doctor said, the left knee in the other hand has this bloody alignment problem and i was advised to do the HTO, the pain is not always there, but no extreme sport activities which is fine with me now i can compromise that, but pain seems developing and i have been reading and reading about it, i even feel i can get a certificate on how much knowledge about this, now i am simply freaking out of doing this, i can not tolerate pain and can not accept the idea of having TKR in the future since i knew that HTO comes with 10 years validity! if i do it now its like TKR at 46 and that makes me sick, please share your tips and experiences, i just cant stop reading more about it and cant reach a decision , i heard of a knee alignment fixing without a surgery, any idea about that ?, thank you all and good luck
2.5 months ago I had a high tibial osteotomy performed by one of the best knee surgeons in the UK. The pain immediately after the operation and for the first 2 weeks was really bad (even with high doses of morphine) as I had severe swelling and was unable to move my leg independently at all. Things have slowly improved and now I can fully take weight and walk as far as I could before. However at this stage I walk slowly with a limp, my leg is still quite swollen and the pain remains worse than it was before the surgery. I need prescription medication to complete my physiotherapy exercises and stay reasonably mobile. My leg is perfectly straight and for that I should be grateful - yet I am missing my 'old' leg that had been there all my life. So far this 'new' straightened version just doesn't feel like mine. I hope things will improve and I will grow to like it.
HTO is major surgery with a very long recovery. I think it should only be done if your knee is shot to bits, you are in agony and you are too young for a knee replacement. I wish I had struggled on with my old leg a bit longer before having this surgery, it was bad but it was better than this.
Based purely on my own experience I would not recommend getting surgery just for cosmetic reasons... only if you are in a lot of pain due to your knock knees. It is major surgery with a long recovery and a significant scar. Please get more than one surgical opinion before making any decision. Good luck :)
Is it possible to operate a both knees surgery together?
How much time does it take to the removal of plate and screws after osteotomy surgery?
How long is the process of recovery after osteotomy surgery?
Last of all, which kind of surgery would I like to do .. HTO or DFO?
I have a problem in walking, when I walk my ankles aren't straight.. They're getting into inward that feels awkward
I would highly appreciate your comments.. Please respond me as soon as possible
into week 2 of Left knee Osteotomy and my calf is swollen / tender and tight - is this common? how long before people can walk without crutches. No knee brace either and partial weight bearing from day 1? cant get the swelling down despite icing 4-5 times a day
Is this all common and just takes time?
I have Torsional malalignment syndrome and more tow weeks i going to do h.t.o (wite elizarov method) and internal fixetion in my hip
and In seven months I plans to operate on the other leg
I Know this is going to be not easy, but the doctor said that day by day it would hurt less
Maybe I'll update how it go later
Good luck to those who have to go through it