CASE STUDY

52-year-old man cycles up the highest mountains in the Alps 18 months after his knee realignment

Andrew’s knee pain is cured following a minimally invasive high tibial osteotomy to realign his leg

Keen cyclist Andrew, 52, started developing knee pain in his mid-forties which was due to an injury he had had 30 years previously when he fractured his right tibia (shin bone) and fibula (calf bone).

Andrew had an arthroscopy which helped a little but then began to develop knee pain once more which made walking difficult. He was referred by a London knee specialist to Professor Adrian Wilson.

Adrian explains: “The main issue was that Andrew was otherwise fit and active at 51 years of age, still working, and he wanted to continue cycling and swimming and, if possible, running.​ On examination, he had varus alignment (bow-leggedness) on the right and couldn’t fully straighten his knee at the fracture site. His X-rays and MRI scans showed that there was arthritic joint damage, but that this was mostly confined to the medial ‘compartment’ of the knee as well as a bit under the kneecap.”

Andrew had been told that the deterioration in his knee, including a lack of cartilage at the weight-bearing point, would probably require a knee replacement, but that he was too young to have this operation.

Adrian advised Andrew to have a minimally invasive high tibial osteotomy to realign his leg. The surgery involved using a bone wedge which means there is less pain than with a traditional osteotomy. The bone wedge is inserted before a plate is screwed in place to hold the altered position of the bones.

Andrew said: “I had the op in October 2016, and was walking comfortably and cycling to work pretty much from February 2017. At 18 months post op I played gentle tennis, cycled round the North Coast of Scotland for a week (450 miles), walked up Pen Y Fan (900m) in the Brecon Beacons, and completed a ride over many of the highest mountain Cols on the Route des Grandes Alpes – a total amount of climbing of 58,000 feet, or twice the height of Everest! My knee has completed all these strenuous activities without pain.”

Andrew said he would advise others in his situation to have the operation, expect it will be painful for the first few weeks while the bone starts to heal, and get active as soon as possible.

“I feel that Andrew is a great example of how such correction can be accomplished with a rapid recovery and little ongoing pain,” added Professor Wilson.

September 2018

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