Knee osteotomy, a surgical procedure that involves cutting and reshaping either the tibia (shinbone) or femur (thighbone), offers a ray of hope for individuals with early-stage osteoarthritis. By redistributing weight away from the damaged portion, this technique can significantly reduce pain and enhance knee function, bringing much-needed relief to those affected.
Understanding Osteoarthritis and Knee Misalignment
Osteoarthritis can occur when the bones in your knee and leg are not properly aligned. This uneven alignment increases stress on either the inner (medial) or outer (lateral) side of the knee joint, leading to cartilage wear and tear over time. The loss of this protective cartilage results in joint pain, stiffness, and reduced mobility.
- Normal Knee Anatomy: A healthy knee joint has even spacing between the femur and tibia, with cartilage acting as a cushion.
- Arthritic Knee: In a knee affected by osteoarthritis, the damaged cartilage causes the bones to rub together, resulting in pain and inflammation.
X-ray imaging often reveals joint space narrowing and bone-on-bone contact in osteoarthritic knees.
Benefits and Limitations of Knee Osteotomy
Goals of a Knee Osteotomy:
- Redistribute weight from the arthritic portion of the knee to the healthier side.
- Correct poor alignment of the knee.
- Extend the functional lifespan of the knee joint.
Advantages of Knee Osteotomy:
- It preserves the patient’s natural knee joint, potentially delaying the need for a partial or total knee replacement by several years.
- Patients can resume their favourite physical activities, including high-impact exercises, once fully healed.
Disadvantages of the Procedure:
- Pain relief may not be as consistent as with a total or partial knee replacement.
- Recovery can be prolonged, requiring up to 6 weeks of healing before bearing weight on the knee.
- Undergoing osteotomy may make future knee replacement surgeries more complex.
Although knee osteotomy is less common today due to the success of knee replacements, it remains a viable option for specific patients.
The Surgical Procedure
Most knee osteotomies focus on the tibia (shinbone) to address bowlegged alignment, which places excess stress on the medial (inner) compartment of the knee. This technique, referred to as a high tibial osteotomy (HTO), was introduced in Europe during the 1950s and gained popularity in the United States in the 1960s.
How It Works:
- A wedge of bone is either removed or added to realign the leg.
- The surgeon uses an oscillating saw to cut the tibia, guided by pre-planned measurements and guide wires.
- The correction is stabilized with a plate and screws while the bone heals.
Medial vs. Lateral Techniques:
- Opening Medial Wedge: A bone graft or synthetic bone is inserted on the inner side of the tibia.
- Closing Lateral Wedge: A small wedge of bone is removed from the outer side of the tibia.
Both techniques create better alignment and even weight distribution across the knee joint. In some cases, osteotomy of the femur (thighbone) is performed to address knock-kneed alignment.
Ideal Candidates for Knee Osteotomy
Knee osteotomy is most effective for individuals who meet the following criteria:
- Age: Typically younger than 60 years old.
- Activity Level: Active individuals with no significant limitations on movement.
- Localized Pain: Pain confined to one side of the knee (medial or lateral).
- Knee Function: Ability to fully straighten the knee and bend it to at least 90°.
Who is Not a Candidate?
Patients with rheumatoid arthritis or those with significant cartilage damage under the kneecap are not good candidates for this procedure.
What to Expect During Surgery
You will likely be admitted to the hospital on the day of the procedure. Here’s what to expect:
- Preoperative Preparation:
- A doctor from the anesthesia department will evaluate your medical history and discuss anesthesia options (general or spinal anesthesia).
- Your surgeon will mark the surgical site to ensure accuracy.
- The Procedure:
- The surgery typically lasts 1 to 2 hours.
- The surgeon will remove or add a wedge of bone, secure it with a plate and screws, and then close the incision.
- Post-Surgery Monitoring:
- After the operation, you will be taken to a recovery room, where medical staff will closely monitor you as the anesthesia wears off.
Recovery and Rehabilitation
Recovery from a knee osteotomy requires patience and adherence to your surgeon’s instructions.
Hospital Stay: Most patients are discharged within 1 to 2 days after surgery.
Pain Management:
- Pain is managed through a combination of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics.
- Opioids should only be used as prescribed, and patients are encouraged to transition to non-opioid pain relievers as soon as possible.
Weight-Bearing Restrictions:
- You will likely need to use crutches for several weeks after surgery.
- A knee brace or cast may be applied to protect the bone as it heals.
- Your surgeon will advise you on when it is safe to begin bearing weight on the operated leg.
Rehabilitation:
Physical therapy will play a key role in your recovery. A physical therapist will guide you through exercises to restore strength and range of motion in your knee.
Timeline for Full Recovery: Most patients can return to their regular activities, including sports and exercise, within 3 to 6 months after surgery.
Potential Risks and Complications
As with any surgical procedure, knee osteotomy carries some risks. These include:
- Infection.
- Blood clots.
- Nerve or blood vessel injuries.
- Stiffness in the knee joint.
- Failure of the osteotomy to heal properly may require a second surgery.
Your surgeon will discuss these risks with you before the procedure and take steps to minimize complications.
Long-Term Outcomes
For most patients, a knee osteotomy successfully relieves pain and slows the progression of arthritis, allowing them to maintain an active lifestyle for many years. While a total knee replacement may still be necessary in the future, an osteotomy can delay this need, particularly for younger patients.
Knee osteotomy is a valuable surgical option for individuals with localized knee arthritis and poor alignment. Redistributing weight and preserving natural knee anatomy provide pain relief and restore function for many years.
If you’re experiencing knee pain, consult with us to determine if a knee osteotomy is right for you.
