Knee osteotomy surgery is carried out on patients experiencing a range of knee conditions, including arthritis and sports-related pain and injury. A knee osteotomy can usually help to significantly delay the need for knee arthroplasty (replacement), and in many instances, remove the need for it altogether.
In patients whose leg bones are not correctly aligned, if they are bow-legged or knock-kneed for example, a knee osteotomy procedure, such as a high tibial osteotomy or femoral osteotomy, restores the normal alignment of the knee joint by correcting the tibia or femur bone, relieving pain and removing pressure on the arthritic or injured area of the knee as a result.
The procedure involves taking pressure off the damaged side of the knee joint by dividing the bone and realigning the bones in the limb, so the leg is straightened.
This realignment of tibia or femur bone helps body weight to be distributed evenly through the knee joint, relieving the pressure on damaged tissue, allowing it to heal, and preserves the joint in the correct position to help avoid problems in the future.
The greatly reduced pain patients feel post-operatively often means they can quickly return to living normal lifestyles. This can be particularly beneficial to active younger and older patients, including those who play sport regularly.
Knee osteotomy surgery offers a less invasive alternative to a knee replacement for patients suffering with arthritis caused by the bones in their legs being misaligned. This misalignment puts additional pressure on the knee joint, causing pain and increasing the damage to the knee.
Another group of patients who may benefit from a knee osteotomy are younger patients including elite sportsmen and women, and active older patients. For these patients, an osteotomy helps them to get back to their previous activity levels more quickly, including competitive sport.
You might need this type of surgery if you are:
Bow-legged – this can result in damage from arthritis to the inner side of the knee joint. Alignment surgery is known as ‘high tibial osteotomy’ where the top part of the tibia (shin bone) is realigned. Around 80% of our realignment procedures are for bow-legged patients.
Knock-kneed – this can result in damage from arthritis to the outer side of the knee joint. Bone alignment surgery is known as ‘femoral osteotomy’ where the bottom part of the femur (thigh bone) is realigned.
Professor Adrian Wilson has pioneered a minimally invasive technique for osteotomy that enables patients to get back to normal activities as quickly as possible. All the results of surgery are carefully monitored so that the procedure is evidence-based. In many cases, the results are comparable to joint arthroplasty.
X-rays will determine the position of the bones in your leg to gauge the correction required to realign your knee.
If you are bow-legged, the high tibial osteotomy procedure involves a wedge being cut into the bone from the outside of the tibia, using precise measurements calculated during a pre-surgery scan. The wedge is removed, and the bone is then pulled slightly apart, using the space created by the removal of the wedge of bone, and fixed into the correct position using a metal plate and pins. The whole leg is realigned during surgery to prevent further damage to the knee.
If you are knock-kneed, surgery involves making cuts into the bone, using precise measurements calculated during a pre-surgery scan. Plates and pins are used to fix the bone into its new position. All the bones in the leg are realigned during surgery to prevent further damage to the knee.
In the UK, the vast majority of patients with arthritis are offered knee replacement surgery. For younger patients with damaged knees where the wear and tear is very severe or even where there is significant bone-on-bone disease (in some cases, down to the bone), the only traditional options would have been to either put up with pain or have steroid injections, which usually provide only temporary benefit.
While knee replacement may be the answer for some people, for others – particularly younger patients, sportsmen and women, and older patients who are very active – removing the damaged knee joint, which also means taking away a great deal of healthy tissue, may not be the best option. Knee osteotomy surgery can usually significantly delay the need for knee replacement surgery (although patients may need this procedure to treat advanced arthritis later on, most commonly 10-15 years later); in some cases, it can avoid the need for it completely.
The main advantages of osteotomy include:
Reduced knee pain without needing to remove/replace your damaged knee joint
A better range of movement and function
The knee can feel more stable than after knee arthroplasty
You can return to your normal activities including competitive sport, which isn’t recommended after a knee arthroplasty as it can wear out the artificial joint
You are not having any bone or tissue replaced, you keep your own knee.
A knee osteotomy usually involves an overnight stay in hospital, although in some cases you may be able to go home the same day. Most people are able to bear their own weight and move freely within 24 hours while full rehabilitation takes between 6-12 weeks. Unless your job is highly active or involves manual labour, you are likely to be able to return to work after six weeks.
Rehabilitation is an integral part of a patient’s knee osteotomy recovery. The London Knee Osteotomy Centre has immediate access to the UK’s best private rehabilitation centres. These provide patients with access to a multidisciplinary team of specialist physiotherapists, occupational therapists, and dedicated rehabilitation gyms.
After a short period of rehabilitation, sportsmen and women are generally able to return to normal activity and competitive sport very quickly.
Elite sportsmen and women have been able to return to normal following an osteotomy and, having regained their fitness levels, they’ve gone on to compete successfully. This includes one elite triathlon runner who, after having his osteotomy procedure, went on to become the top ranked sportsman in his age group.
The London Knee Osteotomy Centre consultants work together as a team to constantly develop the techniques they use to perform knee osteotomy surgery for the benefit of patients. The most recent advances see knee osteotomy being performed as a day case procedure, allowing patients to return home the same day.