Osteotomy literally means cutting of the bone. In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting weight off the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in an arthritic knee.

Purpose of Knee osteotomy/h2>

‣  To transfer weight from the arthritic part of the knee to a healthier area
‣  To correct poor knee alignment
‣  To prolong the life span of the knee joint

Candidates for the surgery

Osteotomy surgery is generally reserved for younger, active patients who have osteoarthritis affecting only one compartment of the knee joint. It has been shown to have a good effect in increasing the lifespan of the natural knee joint and delaying the time before knee replacement surgery becomes necessary.

Types of osteotomy around the knee joint

High Tibial Osteotomy (HTO)
This is the most common osteotomy performed around the knee and is often performed using an opening wedge technique. It is used when there is OA on the medial (inner) side of the knee. Most often, an opening wedge is created on the medial side of the upper tibia to push the weight on to the outer (lateral) compartment of the knee.
Distal Femoral Varus Osteotomy (DFVO)
This is used when there is arthritis in the outer (lateral) compartment of the knee. In order to transfer the pressure to the healthier medial side an opening wedge is made on the lateral part of the lower femur bone.
Tibial Tubercle Osteotomy (TTO)
This osteotomy is used for arthritis or instability of the patellofemoral joint. This operation is discussed in more detail under the section on Patellofemoral Instability.

Surgical Procedures

A knee osteotomy operation typically lasts between 1 and 2 hours. Your surgeon will make an incision at the front of your knee, starting below your kneecap. He or she will plan out the correct size of the wedge using guide wires. With an oscillating saw, your surgeon will cut along the guide wires and then remove the wedge of bone. He or she will close or bring together the bones in order to fill the space created by removing the wedge. Your surgeon will insert a plate and screws to hold the bones in place until the osteotomy heals. This is the most commonly used osteotomy procedure and is called a closing wedge osteotomy. In some cases, rather than closing the bones the wedge of bone is opened and a bone graft is added to fill the space and help the osteotomy heal. This procedure is called an opening wedge osteotomy.

Recovery in Hospital

Whilst in hospital, a physiotherapist will provide instructions on leg exercises that can be performed whilst in bed and also assist you in using crutches to walk. It is common to be on crutches with a closing wedge osteotomy for up to six weeks and occasionally up to 8-10 weeks with an opening wedge osteotomy as it takes longer for this type to heal. Your physiotherapy will focus on regaining knee movement, improving your mobility and maintaining muscular strength around the knee joint. Additionally, you will learn techniques to control the swelling in the knee. Once you are comfortable and are mobilizing safely, your surgeon will allow you to be discharged home. The majority of patients discharged home within two days of the surgery. For the first month, your leg may be swollen and your knee may feel somewhat stiff. It is normal to require regular pain medication during this period. It is extremely important to perform your exercises regularly whilst at home to optimize your outcome following surgery.

Recovery at Home

It can take up to six months before you are fully rehabilitated after a knee osteotomy. The most important part of your rehabilitation is maintaining your strength and motion whilst the osteotomy is healing. It is important during this period that you are diligent with the exercises given to you by your physiotherapist. Physiotherapy generally starts within the first week of your operation.

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