Knee osteotomy





Definition

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.


Purpose

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:

  • Knee deformities such as bowleg in which the knee is varus-leaning (high tibia osteotomy, or HTO) and knock-knee (tibial valgus osteotomy), in which the knee is valgus leaning.
  • A torn anterior cruciate ligament (ACL), which is a set of ligaments that connects the femur to the tibia behind the patella and offers stability to the knee on the left-right or medial-lateral axis. If this ligament is injured, it must be repaired by surgery. Many ACL injuries cause inflammation of the cartilage of the knee and result in bones extrusions, as well as instability of the knee due to malalignment. Osteotomy is performed to cut cartilage and increase the fit and alignment of the ends of the femur and tibia for smooth articulation. As one very common knee injury that often occurs in athletic activity, HTO is often performed when ACL surgery is used to repair the ligament. The combination of the two surgeries occurs primarily in young people who wish to return to a highly athletic life.
  • Osteoarthritis that includes loss of range of motion, stiffness, and roughness of the articular cartilage in the knee joint secondary to the wear and tear of motion, especially in athletes, as well as cartilage breakdown resulting from traumatic injuries to the knee. Surgery for progressive osteoarthritis or injury-induced arthritis is often used to stave off total joint replacement.

Demographics

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.


Description

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.

Diagnosis/Preparation

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.


Aftercare

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.


Risks

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.


Normal results

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 and mortality rates

Morbidity rates include bleeding, inflammation of joint tissues, nerve damage, and infection.


Alternatives

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.

Resources

BOOKS

Ruddy, Shaun, et al., eds. Ruddy: Kelly's Textbook of Rheumatology, 6th Edition. Philadelphia: WB Saunders Publishing, 2001.

PERIODICALS

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).

ORGANIZATIONS

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 .

OTHER

"Osteotomy for Osteoarthritis." WebMD Health. http://www.webmd.com. .


Nancy McKenzie, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


An orthropedic surgeon speciliazing in knee reconstruction surgery performs the operation. Surgery takes place in a general hospital.

QUESTIONS TO ASK THE DOCTOR


  • Are there lifestyle changes, weight, diet, or rehabilitative factors that can help avoid this surgery?
  • How many of your patients have been able to return to normal activities such as walking, running, and climbing stairs after surgery?
  • How many of your patients have been able to return to exercise and to other athletic activities?
  • Is this surgery just putting off my need for knee replacement surgery?
  • How many of these surgeries have you performed?


User Contributions:

Eunice
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Aug 15, 2007 @ 1:13 pm
I was born knock knee and all my life it has affected my self esteem. I would love to be able to wear short skirts and other things that will show my legs but I have always been conscience about my knock knee legs. At the age of 35 is there a Doctor that can reconstructed my legs to normal straight legs. Please respond back
Hella
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Oct 18, 2007 @ 2:14 pm
Could you send me some photos or video of the High Tibial Osteotomy.
Thank you.
cherie
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Dec 23, 2007 @ 11:11 am
I am in my early thirties, and have had numerous arthroscopic proceedures to both of my knees. The cartilage is very soft and well now I am being refferred to a new surgen to see about the osteotomy. This would need to be done bi-lateraly to releave pressure from the medial side of the joint. I was wondering can both knees be done at the same time, or not. I would also appreciate some detailed pictures of the proceedure or a surgical video.
Looking forward to hearing back,
Cherie Krol
gemma
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Apr 26, 2008 @ 6:06 am
I had a knee reconstruction 4 weeks ago and this literature on Knee Osteotomy closely reflects what has been done to my left knee. The only diffference is that I was allowed to weight bear and walk 28 hour after the surgery. Despite of feeling so ill, nauseaus and dizzy!!!

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
Natasha
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May 11, 2008 @ 1:01 am
I am currently recovering from a right tibular rotational Osteotomy. I had it done just over 2 weeks ago. That was the first of 2 i am waiting to have the left knee done aswell.i will be 21 in june. Physiotherapy has helped greatly.
Kemmy
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May 25, 2008 @ 9:21 pm
My entier life I have been teased about my knees, I have slight knock knees and is considering getting them fix. It has affected my self esteem a lot to the point where I donot wear shorts or any clothing showing off my knees. I would like to know do I have to go through that much recovery and physiotherapy after the surgery and what is the price range to get the SLIGHT knock knee fix, or is there any other alternative to geting them corrected..
RAjesh
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Apr 24, 2009 @ 5:05 am
I had an osteotomy 7 years ago to sorrect knock knees as aresult of renal rickets - being 19 years posts a renal transplant and still well. I am experiencing pain in my right knee at the point of osteotomy - the Plates were left in my leg as the surgeon said long term there is no need to remove them - the muscle and bone are sore and I am experiencingg a crinching sound when i flex the kee =- probably due tot he patella being misaligned - do I have a worry or will it heal it self?
wendy o'sullivan
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Jul 26, 2009 @ 11:11 am
i am nearly 5 weeks post op all seems to be healing well, just wondering with knee brace can i sleep without it? happy to wear during the rest of time and have a wedding to attend would it hurt to go without brace if i'm just sitting. thanks wendy
gareth
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Nov 21, 2009 @ 7:07 am
Hi. I have recently had surgery to correct a knock knee. They performed an osteotomy, and am on crutches 5 weeks after surgery. The pain caused by my arthritus prior to surgery has decreaed, with the only pain being caused as my leg resettles in to it's new alignment. I have more x-rays scheduled for 3 weeks, and then hopefully can come of the crutches. It is not an easy procedure, and if thinking of having done, you should be prepared for the long haul in recovery!!! and you also need a lot of patience as you are unable to do anything!!But all in all, I am glad that I had the surgery, and hopefully will be back to football and golf in the not to distant future.
Wanda
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Dec 11, 2009 @ 6:18 pm
I too had this surgery done 4 days ago to correct knock knees. My right leg was way off. Dr. has not yet determined if left knee is needed since it is "within range". I was not aware that surgery could correct my problem until I found it on the internet. Like others, I too was deeply bothered by it. As I look down at my right leg, I get tears in my eyes as I am looking at my straight leg for the first time! Yes, it is painful and I was up for the challenge. For the first time in my life I can talk about this.
Crystal
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Jan 14, 2010 @ 10:22 pm
I also have knock knees and it is the worst for me. I would love to wear dresses and shorts but those things just do not look attractive on me. I was wondering if someone who has been through this procedure would enlighten me on the cost of the procedure. I am 21 and this procedure is needed. Thanks!
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May 31, 2010 @ 10:22 pm
I am in the same boat as a lot of other women, knock kneed. I have very low self esteem about my legs as well. Even when I try to wear somthing short, I hate to look at myself in full lenght mirror because it devastates me to look at my knees. I feel like I am a very attractive young lady except when it comes to that. I would love to know more information on the surgery i.e. cost, recovery, and where I can get it done.
Wanda
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Sep 11, 2010 @ 3:03 am
I'm coming up on a year now since I've had the corrective surgery on my right knee. I used to hate seeing myself walking towards a glass/mirrored door. Now it's a joy and wonder why previous Dr.'s never told me about this surgery. Because of the knowledge the internet offers, I learned I had an option. This week I scheduled surgery for the left knee. I can relate to both Crystal and Domineke. Don't wait as long as I did. Even just getting one leg done is so worth it to your self-esteem and long term physical outcome. My insurance is covering the expense. It is not a cosmetic surgery by far. You need to understand that your knees carry your weight and by being knock kneed, the insides of your knees are carrying your weight. Just like tires on a car that are out of alignment, the knees (cartlidge) are wearing out on the inside and eventually leads to further problems and/or knee replacements. If only I knew what I know now 20 years ago, I wouldn't have been so sad. It is not an easy surgery. Just after 3 months I walked 3 miles. They are right when they say FULL recovery can be up to 6, 8, or 12 months.
Isabel Barros
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Sep 13, 2010 @ 10:22 pm
Hi Wanda, do you have an email, I have some questions about the surgery that I think you'd be helpful with...
James
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Oct 15, 2010 @ 1:13 pm
I am 1 week post op of an acl/hto and am 41 years old. My leg is bandaged and in a 4 strapped brace. Can any one advise me on the correct exercises I can do to start the rehabilitation on my leg? I have read several forums and it appears to me that the 2 procedures have conflicting rehabilitation ie hto no weight bearing for several weeks but an acl requires weight bearing asap.
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
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Oct 27, 2010 @ 10:10 am
Approx. how much time off before returning to work?
Ron
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Nov 7, 2010 @ 9:09 am
I must say if you are having a knee osteotomie you should be prepared for a litle discomfort. I am 49 yr old male that I consider to havig a high tolerance to pain. I am on my 4 th week and I must say it is nasty. I hope it resolves my propblem. I had surgeory done on my miniscous previously but it only led to a very unstable knee, I had 6 weeks of therapy and wore a leg brace for 4 months and then because of further deteriation of the inner part of my knee I opted to a Knee osteotomie. The recovery is much more involved then I asumed not that I did not research it but I assumed my past issues in dealing with pain I would progress quicker then the information that I read. The info online is acurate and make adequite time to let the process to take place. Good luck
Carol
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Dec 10, 2010 @ 8:20 pm
I went to my ortho today with recurring pain on the medial side of my left knee. He asked if I had a redirecting brace. I told him I do but you can't wear it over clothing and it won't fit under my pants. He had me contact someone to find out if there is a way to do this. If that doesn't work he is suggesting the knee osteotomy as a way to put off the knee replacement. I'm 45, too young for a replacement.
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.
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Dec 16, 2010 @ 10:22 pm
I am here 10 days after my 2nd knee osteotomy to correct my left leg. (Per previous posting, I had my right leg done in Dec 2009 - I was knock kneed). I will say that the post surgery has been quite different. One year made a big difference. Before I go into it, let me STRESS, that this was MY experience. At the hospital, they no longer prop your knee up on pillows and do NOT recommend it when you get home. The imobolizer (brace) is not recommended while you are in bed. The straighter the knee is, the better. For this reason, I have had a much more comfortable recovery. I will say that YOU WILL keep your leg straight anyway because it is painful to move any other direction, so by default, you will keep it straight. Dr also told me I could start trying to bend it (a little) after a few days. I tried on about Day 7. It did hurt a little, but the more I do it, the better it gets (no pain, no gain). With respect to the meds, I only take two pain killers at night to sleep and take 2 IB's during the day. After today (10 days), I no longer have to use the immobilizer when I am up. (Yeah!) The other difference is that I am to stay off my left leg completely for another 4 weeks, after that I begin Physical Therapy at which point, I will do an immediate transition to full weight. (Last time it was 2 weeks of no weight, 2 weeks of 1/2 weight, 2 weeks of full weight with crutches, and then 2 weeks of transitioning off crutches)

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!
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Apr 27, 2011 @ 7:19 pm
I was born knock knee and all my life it has affected my self esteem. I would love to be able to wear short skirt, shorts and dresses and other things that will show my legs. At the age of 22 is there a Doctor that can reconstructed my legs to normal straight legs. looking forward to hearing back. Thank Young
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May 7, 2011 @ 8:08 am
I had knee injury,one of my ligerment cut ,how meany days i should start to step it down to be working and playing soccer football.Thanks
Marina
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Oct 31, 2011 @ 4:16 pm
Thank you all for the great information. How is the scarring from the surgery? Does the surgery leave a disfiguring scar? Thanks, Marina
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Nov 18, 2011 @ 12:00 am
Yes, there is a scar, but understand that everyone scares differently and there are things you can do to minimize the scar. Also over time, scars tend to blend in. Google "Vitacilina". That is what I used. It has lots of Vitamin A.

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!
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Dec 16, 2011 @ 11:11 am
I am 24 years of age,from Uganda.i have skeletal deformalities in my legs(bowed leg).Is it possible for me to have corrective surgery to straighten my legs!thanks.
tracey
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Dec 29, 2011 @ 9:21 pm
I'm a 33 yrs n I have knock knees. I hate it so bad , my self esteem is very poor due to this. I would like to do this surgery and I live in NYC. Does anyone knows a good doctor that I can go to in NYC? Plz email me his or her information. Thanks.
tracey
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Dec 30, 2011 @ 6:06 am
I'm a 33 yrs n I have knock knees. I hate it so bad , my self esteem is very poor due to this. I would like to do this surgery and I live in NYC. Does anyone knows a good doctor that I can go to in NYC? Plz email me his or her information. Thanks.
Ady
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Jan 9, 2012 @ 7:19 pm
I'm a 18 year old half Ugandian half Zambian girl and I hav knock knees, and am 2 hav both of them corrected in three weeks time nd leme just say that am so grateful 4 all the information and stories evry1 has shared its just given me evn mre courage 2 fix the one thing tht I've had a problem with throughout my life thank you so much evry1:)
Stellaaaaa
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Jan 14, 2012 @ 1:13 pm
Hi everyone, First, I would like to thank you for all your nice testimonies.
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.
Francis
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Jan 25, 2012 @ 11:11 am
Three months ago i had an arthriscopic procedure in my right knee which is slightly bowed.On enquiry my doctor told me that the right bow-leg can be straightened to avoid further arthroscopic surgeries.He then referred me to a specialist and advised me to go for it.I had been to the specialist who after an examination and ex-rays said that it requires an osteotomy of the knee,also in order to align my right leg with the length of the left one my tigh bone which is slightly bowed would be cut in two places and a metal (rod) be inserted in it to enable me gain my gait,align my hip bones,as well as have my weight evenly distributed on both legs.I am yet to schedule an appointment for the surgery because i need to get more information on the lifestyle changes that would occur after the surgery.I am 39 years old domicile in the United States.Please could you educate me more on this?Thanks.
Jacqueline
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Feb 9, 2012 @ 12:12 pm
Francis - the type of surgery you are talking about might be a bit out-dated now. High-tibial osteotomy (rotational) - may be what you are after. I met with a surgeon 20 years ago and he told me the rods were the only option. It seemed too drastic to me and I did not go ahead with surgery. Just recently I have found out about high-tibial osteotomies -- Google it -- it is a newer procedure used to correct bowing, and arthritic knees and misalignment. While of course I cannot possibly know if this is right for you, you should explore it with an orthopedic surgeon who has performed many of them. There is a great blog called Notacowgirl blog -- Google it for more info - it provides a lot of info, including from people who have had HTOs done.

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!
Robert
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Mar 27, 2012 @ 1:01 am
Hi

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
linda
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Mar 30, 2012 @ 8:20 pm
Im on my 3rd week of hto without a brace. This is because i have a plate and screws inside. No weight on my leg for 6 weeks and no physio. Just have to make sure leg is straight when laying down and let the weight of your leg gently bend it when your sitting. Hope this helps.
linda
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Mar 30, 2012 @ 8:20 pm
Also Rob, you should have been prescribed pain medication. This would also help your sleeping. There should be no need for that mmuch pain. Good luck.
Sheena
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Apr 18, 2012 @ 12:12 pm
Hello. It has been almost 3 weeks since I had knee arthroscopic and osteotomy surgery on my right knee. The reason for me needing this surgery is due to the fact that I am severely knocked kneed. Being an active 28 year old woman, I had noticed a consistent increase of pain in both my knees over the past few years. After initially having arthroscopic surgery and returning to my doctor with more increased pain, he felt I would benefit significantly from osteotomy surgery. Having undergone many surgeries last year to multiple joints in my body (all arthroscopic), I wasn't sure what to expect with this surgery. Realizing that no two surgeries are the same, I thought I would share my experiences thus far.

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?...
Glynn Osborne
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May 30, 2012 @ 2:02 am
Hi I am 41 and just had my leg strainten from being bow legged and it looks amazing if any one wants to no more email me thank s:) gud look all .
Zalman
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Jul 22, 2012 @ 3:15 pm
Eighteen years ago when 63, my Mayo Clinic Surgeon and his team performed a double osteotomy to alleviate severe knee pain due to uneven cartilage wear. Following recovery lasting about 3 months I was able to work and perform most tasks without any problems and also exercise vigorously. One month ago the same Mayo Clinic surgeon removed the osteotomy hardware used and performed a total knee replacement. Within two weeks I was walking without any aid, using only home rehab exercises. Residual tightness remains in the quads and hamstring, but is diminishing day by day. I use icing daily. The added surgical procedure required to remove hardware caused substantial trauma to the quad/hamstring. patellar tendon areas and has prolonged my full recovery. However, I am very happy about the outcome and can anticipate a full recovery shortly. Thanks Mayo Clinic!!!
suleiman
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Jul 24, 2012 @ 4:04 am
hi am also knock kneed and would love to have it corrected in india.anyone of help please.we are one family. suleiman-mohamed@hotmail.com
Serena
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Jul 25, 2012 @ 9:09 am
Hi. For those who did knee osteotomy, would it be advisable to take out the metal plate? I had both knees done in 2010 and 2011, trying to get back active lifestyle like running but there is somehow a lot weakness on the upper thigh. Not sure if any one of u faced that? Could it be irritation from metal plates?
Samuel
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Jul 25, 2012 @ 10:10 am
@Wanda... I just had d same surgery,mine was a bow leg corrected to being straight and I'm presently still on d hospital bed,it's been A a week and a half now...so I wanted to ask if u knw how long it wud take for the "wound" to heal not the bone "wound" thanks,and if u're any chance using a blackberry here's my pin 32FACC62.Thank you
Traceelements
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Aug 7, 2012 @ 11:11 am
Well after just reading all of your comments and stories of your experiences on this page,I am both excited and a little hesitant of what I'm in for soon,as today I got the news from my specialist that I too will be having the Osteotomy surgery to correct an ongoing dislocation patella problem that i have suffered with since i was in my teens,I am now 47 yrs old and have severe arthritis and very worn cartlidge and knee joints,Doc says he will be cutting the tibia and inserting the screws and pins,can anyone tell me from their experience do they later remove these down the track or leave them in,and how have many of you gotten on much later on possibly years later after your surgery's have you made a full recovery,being the age I am I am really hoping for a speedy recovery and much better quality of life with my legs,and hopefully less pain to bear than i have had to contend with all these many years...
Nicki
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Aug 29, 2012 @ 11:11 am
@ Glynn Where did you get your op done? I'm looking for a surgeon in the UK and what did it cost? Hope you are recovering well.
Ian
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Sep 19, 2012 @ 8:08 am
I am a 52 year old relatively fit male living in the UK.
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 !!!
Marie
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Oct 6, 2012 @ 1:13 pm
I had a high tibial osteotomy (opening wedge) two years ago. After a lengthy recovery I am now spending my time at spin and pump classes, doing everything and more than I could before. I have pain in my tibia caused by the 'plate' and am having the plate removed in a couple of days. I am pleased to have had the HTO despite the pain in the tibia I currently have.
DJ
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Nov 18, 2012 @ 7:19 pm
I had a femoral osteotomy almost three months ago. It involved two breaks: one open wedge and one sliding. I am 26. My plate runs along just about the entire length of my femur, and has seven screws. The incision itself is 24 inches long, after surgery held with 50 staples and two drains. My surgery in particular took 7.5 hours and I needed two blood transfusions afterward.

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.
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Nov 27, 2012 @ 1:13 pm
Hi 41 yrs I had hto on sept 17 ,2012 . I had 7 mm wedge on medial side . After the surgery my knee felted great , no swelling , no pain , stop taking the drugs 2 day after the surgery . It's been 9 weeks now ,I been at physio and working out on bike at home . I think I made poor choice I when on the ice to help coach my daughter hockey team because the other coach was stuck at car accident . When I first stepped on the ice my knee felt weak , as I started ice around it felt better . Also was wear my brace from acl repair from years ago. After the practice I went home, it felt ok . The next morning both insides of my knees were on fire . It's been 3 days now and my knees both are aching like crazy . I hope I did't screw up my knee going on it to early ? Does anyone have any insight on this matter ? It's aching more laying bed then walking . Cheers Jason
hannah
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Dec 4, 2012 @ 11:11 am
I have searched and searched the web but i can't find any hospital where i can ger this surgery done. Please can someone help me and just tell me which hospitals can correct knock knees. All my life i have been affected emotionlly by this. i am so depressed and just want it done. I am from scotland so where is the closest place for me where i can get this done.

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
Wanda
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Dec 12, 2012 @ 10:22 pm
Same Wanda from earlier posts.
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!"
Robin
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Apr 2, 2013 @ 10:10 am
Wanda, thank you so much for your posts. Would you be willing to tell me the name of the hospital and doctor that performed your surgery? I would greatly appreciate it! Also, could you tell me what type of scaring I might expect after this type of surgery?
Thank you again so much!
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Jul 13, 2013 @ 1:13 pm
Am 87 years of age, female, just completed chemo for lymphoma Is it too late to consider straightening of left knock knee? Had slight bowleg in right and had total knee replacement two years ago which has done well. Wearing brace n left leg at present.
Ady
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Oct 1, 2013 @ 8:08 am
Hai Every one its been 9months since my knock knee corrective osteotomy and I'm back to doing all my usual things I walk about 4km a Day with no strain or Pain; I had mine done at Apollo hospital in New Delhi India cost me about $ 6000 and honestly I think it was worth it I've gained so much confidence and I can't wait to do my right leg as well, the scarring is not too bad its about 11inches long and half of a centimeter wide and bio oil has really hepled too I did hav a stitch abcess post surgery but I hear thts normal and it closed up within 3weeks; I'm to go and have my other leg done pprobably end of next year cause I'm busy with flight school at the moment anyway I just thought I'd share my experience the plate hasn't given me any issues yet though it goes hurt when its cold but all in all the surgery is worth it !
Nadine
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Feb 4, 2014 @ 3:15 pm
I am planning to have a surgery for bow leg. Would you recommend any hospital, surgeon in London. Thank you.

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