KNEE REALIGNMENT SURGERY (OSTEOTOMY)

Adrian is considered to be a global leader in the field of knee realignment (osteotomy) surgery. The procedure involves taking pressure off the damaged side of your knee by dividing the bone and realigning the limb so the leg is straight. This realignment allows your body weight to be distributed evenly through the knee joint. This in turn relieves the pressure on damaged tissue, allowing it to heal, and preserves the joint in the correct position to help avoid problems in the future.

Adrian has pioneered a new method of osteotomy surgery that is minimally invasive and computer aided, enabling him to precisely plan and carry out corrective surgery to any abnormalities in the knee.

As well as being one of the first surgeons to offer this new procedure, Adrian has designed and manufactured his own range of surgical instruments; these ensure that the accurate measurements taken when he plans a procedure are translated into precise surgical techniques. The metal plates and pins that he uses hold the bone in place so rigidly that patients can support their full weight on the knee joint within 24 hours of surgery.

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 shin bone is realigned. Around 80% of Adrian’s realignment procedures are for bow-legged patients
• Knock-kneed – this can result in damage from arthritis to the outer side of the knee joint. Alignment surgery is known as ‘femoral osteotomy’ where the bottom part of the thigh bone is realigned

Adrian 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 treatment is evidence based. In many cases, the results are comparable to joint replacement surgery.

• If you are bow-legged, surgery involves a wedge being cut into the bone, using precise measurements calculated during a pre-surgery scan. The bone is then pulled slightly apart 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. The whole leg is 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 where the wear and tear is very severe or even where there is severe 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 surgery may be the answer for some people, for others – particularly younger patients, sportsmen and women, and older patients who are very active – removing the knee joint, which also means taking away a great deal of healthy tissue, may not be the best option. Osteotomy 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 knee replacement altogether.

The main advantages of osteotomy over knee replacement include:

• Reduced knee pain without needing to remove/replace your knee joint
• A better range of movement and function
• Faster recovery
• The knee can feel more stable than after knee replacement surgery
• You can return to your normal activities including competitive sport, which isn’t recommended after a knee replacement as it can wear out the artificial joint
• You are not having anything replaced, you keep your own knee.

Most people are able to bear their own weight 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.

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 surgery, went on to become the top ranked sportsman in his age group.