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What Is Knee Osteotomy?
Knee osteotomy is a surgical procedure that reshapes and realigns the bones of the knee. This procedure is popular among younger active patients who want to avoid a full knee replacement. Results from knee osteotomy can include reduced or relieved pain and increased mobility.
What Can Knee Osteotomy Achieve?
Osteotomy is a type of surgery that removes part of a bone or bones to reshaped or realign them. It is usually done to adjust the weight distribution on the bone which can relieve symptoms such as pain and inflammation. It can be used throughout the body. This overview focuses on knee osteotomy.
Some of the most common conditions that lead to knee osteotomy are:
- Varus knees (known as being “bow-legged”)
- Knee issues in young, active people who may ‘wear out’ a knee replacement
Sometimes osteotomy is performed on the knee to delay the need for a knee replacement. As the damage is likely to worsen with age, an early osteotomy may prevent the need for a full replacement knee for quite some time.
During your consultation, your surgeon will explain what knee osteotomy is and what you can expect during and after the surgery. Your personal goals, expectations, and what you may or may not be able to achieve from knee osteotomy will also be discussed.
Who Are BOA?
The BOA or British Orthopaedic Association is the leading orthopaedic organisation in the UK. Member join training sessions to update themselves on the latest developments in orthopaedic diagnostics and treatment, meaning surgeons that join BOA are some of the top orthopaedic surgeons available in the UK. This is why at Medbelle we're motivated to recruit BOA member surgeons to ensure our patients receive only the highest quality of care.
How Is Knee Osteotomy Surgery Performed?
Before your procedure, you will be asked to attend an appointment to assess your fitness for surgery. This will generally involve being asked some questions about your health and any medications or supplements you may take.
Signing the Consent Form
On the day of the arthroscopy, you will meet with your surgeon. They will go over the details of the procedure again, make sure that you understand everything and that you are happy to go ahead and ask you to sign a consent form. This is a legal document that legally shows you understand the procedure you are having and the potential risks and gives your surgeon consent to operate on you.
Once the consent form is signed, your anaesthetist will administer the anaesthetic. Depending on what you and your surgeon discussed previously, they will either administer general anaesthesia or a spinal block.
One the anaesthetic is working the surgeon will sterilise your knee and make a small incision at the front of the knee. They will assess the bones in the knee and mark the area to be removed. This is then cut away and the remaining parts are realigned and/or fitted together. The joint is secured with a metal plate that is screwed into place.
Closing the Incisions
The incision at the front of the knee is then stitched closed with sutures or another method. The wound is then dressed, and the surgery is over.
Return to the Ward
You will then be taken to the ward or recovery area and monitored as the anaesthetic wears off. In most cases, you will be able to go home on the same day providing you have recovered from the anaesthetic and the surgeon believes it is safe for you to do so.
Follow up Appointments and Physiotherapy
Your surgeon and physiotherapist will recommend a course of physiotherapy and/or further treatments to aid in proper healing. It is vital you follow the advice and recommendations of your surgeon and medical team throughout your osteotomy journey in order to get the best results possible.
Who Is the Ideal Candidate for Knee Osteotomy?
Knee osteotomy can relieve symptoms of conditions such as osteoarthritis or alignment problems.
In the case of osteoarthritis, it is important you only have symptoms on one side of your knee. Knee osteotomy is a great option for patients who have already tried medications (such as pain relief) and tried physiotherapy to improve your symptoms but have not had good results.
The ideal candidate for knee osteotomy may also have the following characteristics:
- Be generally fit and well
- Have a BMI below 35
- Have symptoms that negatively everyday activities
- Be able to understand and follow recovery guidance including physiotherapy
- Does not suffer from rheumatoid arthritis or another inflammatory condition
- Has an otherwise healthy knee with no ligament or kneecap problems
As a general anaesthetic may be required, it is important that a thorough health and medication history is taken ahead of the procedure. It may also be possible to do an osteotomy using an anaesthetic called a spinal block. Also called an epidural, this is the same anaesthetic commonly performed during childbirth that allows the patient to remain awake but keeps them from feeling any pain below their waist. Your surgeon will talk you through the anaesthetic options so you can decide together on your best and safest option.
To get the most out of your knee osteotomy and sustain the long-term health of your knee, it is very important to understand and be committed to the recovery process. This includes attending all follow-up appointments and to adhere to physiotherapy guidance. These exercises help ensure timely healing and aim to get you the best end results possible.
Risks and Complications
What Are the Most Common Knee Osteotomy Complications?
As with all surgical procedures, there are potential risks and complications that you should be aware of before agreeing to have knee osteotomy. Your surgeon will be happy to discuss these in full with you ahead of your operation or at any step along the way.
The risks and complications related to knee osteotomy include:
General Surgical Risks
Every surgery comes with risks. These can range in severity and may include complications with anaesthetic, nausea, vomiting, post-operative pain, and blood clots.
Swelling and Bruising
The knee is prone to bruising and swelling after arthroscopy. These tend to resolve after a few days. Your doctor may prescribe pain medication to help to limit any discomfort you may feel because of bruising or swelling while you heal.
Infection is a risk of any surgery. This can be a serious complication and may require antibiotics and/or further surgery to treat.
Signs you may have an infection include:
- Feeling feverish with a temperature above 38° C
- Increasing redness or swelling around the wound site in the first 2 days after surgery
- Yellow pus or foul-smelling fluid coming from your incisions
- Pain that is not relieved by painkillers
If you believe you have an infection, seek urgent medical advice and contact your surgeon.
Bleeding in the knee is a common complication after knee osteotomy. It may cause excessive pain and swelling after the procedure. If severe, it could require further treatment or revision surgery.
Damage to Surrounding Structures
Your surgeon will always aim to avoid damaging any part of your body during surgery, however, damage may occasionally happen because of the way the leg and knee must be moved during surgery.
Damage to nerves, ligaments, or blood vessels near the knee may cause the following symptoms:
- Loss or change in sensation
- Mobility issues
While uncommon, these complications may result in the need for further or revision surgery.
Preparing for Your Treatment
How Can I Prepare for My Knee Osteotomy?
Although most people return home the same day you may wish to do some preparation at home to help make your recovery as relaxing as possible. It is important to remember that it may take time to return to your previous mobility and you may be in some discomfort. Further, your surgeon may advise you to avoid certain activities altogether for a while. Some suggestions for preparation:
Smoking and use of nicotine products like e-cigarettes or nicotine gum interfere with wound healing and increase the likelihood of complications. This is because nicotine constricts blood flow and slows healing as a result.
It is recommended you stop smoking and using nicotine at least six weeks before and after your procedure.
Everyday chores may be very difficult or advised against for you to do for a few days after you return home after knee osteotomy. We recommend getting as much done around the house before you go to the hospital.
It is also a good idea to stock your kitchen and even prepare and freeze meals so you can eat healthfully as you heal instead of worrying about cooking or relying on takeaway food that can be high in salt which in turn increases swelling.
Child and Pet Care
You may find it helpful to arrange for extra support from friends, family, or a sitter to care for children and/or pets whilst you recover.
Transport Home from Hospital
You will not be able to drive yourself home after the hospital the day of your surgery because of the effect of anaesthesia on your judgement and coordination, so ensure you have arranged transport beforehand. If needed, your Medbelle PCA can help arrange this for you.
Your doctor will advise you on when you can begin to drive again, which may be several weeks. Consider making alternative transport arrangements until you can resume driving.
Wear loose trousers, shorts or a skirt on the day of your surgery and be prepared to wear these types of clothes as you heal. This is to ensure your clothing does not rub on the surgical wound on your knee as you heal. Choosing loose-fitting clothing can also make dressing and undressing much easier.
What Can I Expect After a Knee Osteotomy?
After your knee osteotomy, you will likely have to stay in hospital for at least one night. The medical staff looking after you will encourage you to stand up and move on your own. When you can do this, you will be able to go home, providing that everything else regarding your recovery is fine.
You will need to use a mobility aid like a walker or crutches for between 6 to 8 weeks and will be able to bear your full weight on your knee between 2 to 3 weeks.
Time Away from Work
The time you need away from work is dependent on your health and the type of work you do. If you have a low-impact job (for example in an office setting) you will be able to return to work when you can safely and comfortably travel to and from work. Depending on how quickly you heal, this could take up to 6 weeks.
If your work is more labour-intensive, you may need to be away for up to 3 months.
Your surgeon and physiotherapist will be able to provide you with a more precise estimate as to how much time you will need away from work to heal.
As with work and sports, you may only return to driving after you have healed when you can safely control a vehicle. The range of movement and strength of your knee will be the deciding factors in this. It may take you up to 6 weeks to comfortably and safely drive.
Dressing and Stitches
Your incision will be closed with sutures or staples after surgery and a dressing will be applied to keep the wound protected as it heals. A dressing will need to remain on the incision until the sutures or staples are removed.
You should not submerge or wet your surgical wound before the sutures are taken out. Your surgeon will tell you when it is safe for you to fully bathe or shower again.
Physiotherapy is a crucial component to healing from knee osteotomy. You will likely see your physiotherapist weekly. During these appointments, you will learn exercises that help improve the strength and mobility of your knee as it heals. Attending these appointments and performing the exercises and stretches at the recommended intervals (once to three times a day) is vital to ensure you heal well after knee osteotomy.
You may also need hydrotherapy during your healing, meaning you will do exercises in a warm pool to reduce the stress on your knee as you exercise.
Every patient heals at a different rate so it is difficult to estimate when you will experience the final results of your knee osteotomy. A majority of patients find relief from knee pain soon after their osteotomy.
Generally, many patients are able to resume their normal actives, sports, and hobbies after 6 months, though full recovery may take up to 12 months for some.
Knee Osteotomy FAQs
How long until I am back to my normal activities after knee osteotomy?
Recovery varies from patient to patient. This ultimately depends on the type of osteotomy, your general health, as well as your underlying knee problems. You will likely be given crutches to use for the first two to four weeks and may be able to gradually return to some physical activity after this.
You may be able to return to work if safe to do so when still using your crutches. This is depending on your occupation, whether it is safe to do so and your surgeon's advice. It may take several months of physiotherapy and recovery before returning to higher-impact activities and sports. Your doctor and physiotherapist will give you a personalised timeline for what to expect.
Will knee osteotomy solve my knee pain?
People vary greatly and it is, therefore, difficult to give a generalised answer to this type of question. If the aim of an osteotomy is to relieve pain then you may see an improvement soon after the procedure.
In general, most people do see improvements after knee osteotomy surgery. Your surgeon will discuss your goals and the post-op physiotherapy process to help decide if it is a realistic way for you to achieve your goals.
Are there any alternatives to knee osteotomy?
In general, knee conditions can be treated in several ways:
- Conservatively - with rest, physiotherapy and rehabilitation.
- Medically - with anti-inflammatory or pain killer medications.
- Surgically - with a procedure such as an osteotomy.
If you have not tried all the non-surgical options, it may be advisable to discuss these with your doctor before considering surgery. here are risks associated with any surgery and these may outweigh the benefits of an operation if it is not necessary.
A surgical alternative to an osteotomy is partial or total knee replacement. Osteotomies can be a better option for younger people as knee replacements can wear out in time and may need replacement (revision) every 10 to 15 years, meaning the potential for multiple replacements in a lifetime. Further, revision surgery can be more challenging to perform and results are not guaranteed.
Your surgeon will explain the alternative treatment options, answer any questions you have, and help you come to a decision that is right for you.