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Osteotomy of the knee

Definition

Osteotomy of the knee is surgery that involves making a cut in one of the bones in your lower leg. This can be done to relieve symptoms of arthritis.

The surgery is called a tibial osteotomy if the cut is made on the shin bone.
The surgery is called a femoral osteotomy if the cut is made on the thigh bone.

Alternative Names

Proximal tibial osteotomy; Lateral closing wedge osteotomy

Description

During surgery:

You will be pain-free during surgery. You may get spinal or epidural anesthesia, along with medicine to help you relax. You may also receive general anesthesia, in which you will be asleep.
Your surgeon will make a 4 - 5 inch surgical cut on the area where the osteotomy is being done.
- If you are having a tibial osteotomy, the cut is made below the kneecap.
- If you are having a femoral osteotomy, the cut is made above the kneecap.
For a closing wedge osteotomy, the surgeon may remove a wedge of your shinbone from underneath the healthy side of your knee.
For an opening wedge osteotomy, the surgeon may also open a wedge on the painful side of the knee.
Staples, screws, or plates may be used, depending on the type of osteotomy.
You may need a bone graft to fill out the wedge.

The procedure usually takes 1 to 1 1/2 hours to perform.

Why the Procedure Is Performed

Osteotomy of the knee is done to treat symptoms of knee arthritis that no longer respond to other treatments.

Arthritis most often affects the inside part of the knee. The outside part of the knee usually isn't affected. This often occurs because the inside of the knee holds more of your weight than the outside of the knee when you walk and stand.

Knee replacement surgery may not be the best option for some people. By having an osteotomy, you and your doctor may be able to delay a knee replacement for up to 10 years, while still allowing you to stay active.

Osteotomy surgery works by shifting the weight away from the damaged part of your knee to the other side of the knee when you stand. For the surgery to be successful, the side of the knee where the weight is being shifted should have little or no arthritis.

Risks

The risks for any anesthesia or surgery are:

Allergic reactions to medicines
Breathing problems
Bleeding
Infection

Other risks from this surgery include:

Blood clot in the leg
Injury to a blood vessel or nerve
Infection in the knee joint
Knee stiffness or a knee joint that is not well aligned

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
Ask your doctor which drugs you should still take on the day of your surgery.
Tell your doctor if you have been drinking a lot of alcohol -- more than 1 or 2 drinks a day.
If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.

On the day of your surgery:

You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
Take the drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

By having an osteotomy you may be able to delay the need for a knee replacement for up to 10 years, but still stay active.

A tibial osteotomy may make you look "knock kneed." A femoral osteotomy may make you look "bow legged."

Outlook (Prognosis)

Your doctor may fit you with a brace to limit how much you're able to move your knee during the recovery period. The brace may also help hold your knee in the correct position.

You will likely need to use crutches for 6 weeks or more. At first, you may be asked to not place any weight on your knee.

You will see a physical therapist to help you with an exercise program.

Complete recovery may take several months to a year.

References

Dabov G. Miscellaneous nontraumatic disorders. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 25.

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