Osteotomy of the Knee

Description

There are two types of surgery:

• Tibial osteotomy is surgery done on the shin bone below the knee cap.
• Femoral osteotomy is surgery done on the thigh bone above the knee cap.

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 to 5 inch cut on the area where the osteotomy is being done.
• The surgeon may remove a wedge of your shinbone from underneath the healthy side of your knee. This is called a closing wedge osteotomy.
• The surgeon may also open a wedge on the painful side of the knee. This is called an opening wedge osteotomy.
• Staples, screws, or plates may be used, depending on the type of osteotomy.
• You may need a bone graft to fill in the wedge.

In most cases, the procedure will take 1 to 1 1/2 hours.

Why the Procedure Is Performed

Osteotomy of the knee is done to treat symptoms of knee arthritis. It is done when other treatments no longer offer relief. Arthritis most often affects the inside part of the knee. Most of the time, the outside part of the knee is not affected unless you have had a knee injury in the past. Osteotomy surgery works by shifting the weight away from the damaged part of your knee. For the surgery to be successful, the side of the knee where the weight is being shifted should have little or no arthritis.
Risk

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
• Stiffness in the knee
• Failure of the fixation that requires more surgery

Before the Procedure

Always tell your health care provider which drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:

• Prepare your home for knee osteotomy recovery
• Ask your provider which medicines you can still take on the day of your surgery.
• You may be asked to stop taking medicine that makes it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), blood thinners such as warfarin (Coumadin), and other drugs.
• You may need to stop taking any medicines that weaken your immune system, including Enbrel and methotrexate.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see the provider who treats you for these conditions.
• Tell your provider if you have been drinking a lot of alcohol (more than one or two drinks a day).
• If you smoke, you need to stop. Ask your health care providers for help. Smoking slows healing and recovery.
• Let your provider know if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.

On the day of your surgery:

• You may be told not to drink or eat anything for 6 to 12 hours before the procedure.
• Take the medicines your provider told you to take with a sip of water.
• Your provider will tell you when to arrive at the hospital.

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 “knockkneed.” A femoral osteotomy may make you look “bow legged.”

Outlook (Prognosis)

You will be fitted 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 need to use crutches for 6 weeks or more. At first, you may be asked to not place any weight on your knee. Ask your provider when it will be OK to walk with weight on your leg that had the surgery. You will see a physical therapist to help you with an exercise program. Complete recovery may take several months to a year.