The word ‘osteotomy’ means cutting of the bone. It is a surgical procedure done when arthritis damage affects only one area of the knee. The tibia called as the shinbone or femur called as thigh bone is cut or may be reshaped to shift the body weight from the damaged side of the knee to the other side of the knee which is not affected by arthritis damage. The surgery results in correction of knee alignment and improvement of knee function. The two types of knee osteotomy are:
High tibial osteotomy: reshaping of the tibia which is below the knee cap
Femoral osteotomy: reshaping of the femur bone which is above the knee cap
The most common type of osteotomy performed is high tibial osteotomy.
It is indicated in patients where arthritis damage is on only one side of the knee joint. Knee osteotomy is preferred over total knee replacement in relatively young patients (40-60 years of age) so that healthy knee portion can be used for few more years. To undergo knee osteotomy, patient should not be overweight and must also have good knee mobility.
The patient will be asked to stop certain medications that cause blood thinning or that suppress the immune system, at least two weeks prior to the surgery.
Smoking should also be stopped at least two weeks before the surgery as it interferes with the healing process.
The patient will be on fasting for 8-12 hours before the surgery.
The surgery is done by an orthopedic surgeon under general anesthesia/spinal or epidural anesthesia. The procedure can take up to two hours.
An incision is made on the area where osteotomy is to be done.
In high tibial osteotomy, a precise wedge of bone is removed from below the knee cap, which causes the leg to bend slightly inwards. The weight is transferred to the outside/lateral portion of the knee.
Staples/plates/screws may be used to close the gap. Bone graft from the patient/ donor or synthetic bone graft may be used to fill out the wedge.
The new knee alignment will be checked again and the surgical wound will be closed.
The selected tendon is harvested and the graft of the correct size is prepared.
Risk and Complication
As with any surgery, there is risk of reaction to anesthetic medications. The patient may have breathing difficulty; there is also risk of infection and excessive bleeding. There may be formation of blood clot in the legs and a blood vessel or nerve may be injured. There may also be knee stiffness post surgery and knee joint may not be properly aligned.
It is also called as proximal tibial osteotomy; lateral closing wedge osteotomy or distal femoral osteotomy. Knee osteotomy will prolong the life span of the knee joint and postpone the need for knee replacement and also allows a younger patient to lead a more active lifestyle for more years.
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