Osteotomy

About

Osteotomy is an operation which changes the alignment of the lower limb by cutting the tibia or femur, and adding or removing a wedge of bone. It is most commonly done for arthritis which is localised to one compartment of the knee. This is often due to deformity or malalignment of the lower limb which results in excess weight being transferred through that part of the knee.

The procedure is done by creating a controlled fracture, most commonly in the tibia (shin bone) just below the knee, or occasionally the femur (thigh-bone) just above the knee. The knee can then be altered to a more natural alignment, and fixed in place using a plate and screws. The weight on the worn part of the joint being decreased and pressure transferred to the less worn areas.

The main goal of osteotomy is to decrease the pain associated with arthritis, improve function, and slow the progression of the condition. It is usually done for patients who are younger and more active than those requiring knee replacement.

Be Aware

Rehabilitation after the osteotomy procedure is very important to improve movement and muscle strength and begins with a physiotherapist six weeks after surgery. It takes most patients about six months to fully recover. It is possible to resume a sedentary job three to four weeks after surgery, but it can be at least three to four months before physical work is possible. Patients need to wait between six and twelve months before resuming sport.

Most patients feel improvement in their knee following tibial osteotomy. A few (5-8%) are unimproved and 2% are worse. The improvement seen following tibial osteotomy lasts a variable time depending on how well the patient cares for the knee, how much damage was already done by arthritis before the operation, and the inherited quality of the articular cartilage. For over 70% of patients the improvement following osteotomy lasts for ten years or more.

Risks for osteotomy are;

• Infection: Deep bony infection is very rare but if this occurs and is untreated, serious problems follow.
• Blood Clots: Medication and stockings are used to help prevent clots. A clot which travels to the lung can be fatal, although this is extremely rare. Chest pain and calf pain can be symptoms of a clot and must be reported to the surgeon immediately.
• Poor Bone Healing: In approximately 2% to 3% of patients, the bone may not fully heal or slip in position whilst healing. This is monitored by x-rays of the bone. Occasionally, revision surgery may be required to promote bone healing.
• Nerve and Vessel Injury: Major nerves and arteries which supply the leg are in the vicinity of the surgery. Although rare, damage to these is possible.
• Other complications include hematoma, superficial infection and knee stiffness.