Planning your osteotomy operation

High tibial knee realignment (osteotomy) surgery is when the tibia, or shinbone, is cut and reshaped to remove pressure from the knee joint. It’s normally used to treat arthritis and to correct a bowlegged deformity that has caused damage to one side of the knee. It can delay – or even avoid the need for – joint replacement surgery.

• Adrian makes a cut at the top of the tibia (shinbone), within a few centimetres of the knee. A surgical instrument is used to widen this cut into a pie-shaped wedge which, when it is closed, straightens the leg and allows the knee to carry weight more evenly as well as reducing pressure on the painful side
• The next step is to fix the opening in place so that the bones remain aligned. A strong plate is screwed in place into the bone to hold the wedge securely
• The screws holding the plate in place extend most of the way through the bone
• The incisions are then closed and the operation is concluded

Distal femoral knee realignment (osteotomy) involves changing the shape of the knee joint in order to take the load off the side of the knee affected by arthritis and increase the load on the other side. In some cases, it can delay – or even avoid – the need for joint replacement surgery. It is similar to having a high tibial osteotomy in terms of planning your operation but the cut in the bone is made in the lower end of the femur (thigh bone) to correct a knock-kneed deformity.

• The operation is usually carried out by removing a wedge of bone from the inside of the thigh bone
• The gap created is then closed and held rigid with a strong plate and screws. This corrects the alignment of the bones and the closure of the wedge provides much greater stability after surgery
• The two sections of bone that are fixed together will heal completely after surgery to form one bone

Research carried out by the World Health Organization demonstrated that patients who have the knowledge, skills and confidence to manage their own condition enjoy better outcomes. ¹Your experience of having osteotomy surgery is likely to be more positive, and your recovery faster and more successful, if you make sure that you understand the procedure, prepare for surgery, and carry out any exercises you have been given as part of your rehabilitation programme – including strengthening the muscles around the knee joint before surgery.

After you’ve had your pre-operative tests, it’s important to follow the advice you’ve been given. This includes:

• If you smoke, you must stop at least three months before the operation and not restart for at least three months afterwards. This is because the toxins in smoke can affect blood flow through your bones and prevent healing. Smoking also increases your risk of healing slowly, having an infection, and other complications
• Following the instructions from your healthcare team about taking any medication in the week before your surgery, the day of surgery and afterwards. This is particularly important if you are taking blood-thinning drugs such as warfarin which can increase bleeding during surgery
• Following any instructions you’ve been given about fasting (including drinking) before your operation. This is to avoid problems associated with the general anaesthetic, such as nausea
• You may be advised to use a muscle stimulator before surgery – and up to 12 weeks afterwards – to improve your muscle strength. This in turn will help your bones to heal faster and enable you to be as mobile as possible after your operation
• Arian will also advise you about the level of activity you can safely do while you are waiting for surgery

You’ll be encouraged to get up and move around within a few hours to help blood flow and reduce your risk of deep vein thrombosis (DVT). Moving your knee joint will also ease stiffness.

During your operation, Adrian will inject local pain relief into your knee joint so that when you wake up you should have little or no pain. After this, you’ll be given pain relief as and when you need it and, once you return home, you can take over-the-counter painkillers as advised by your doctor for the following days. However, it’s important to avoid taking anti-inflammatory painkillers such as ibuprofen after surgery as these can prevent the bone healing.

Although the risks from having knee realignment (osteotomy) surgery are low, complications can include: infection, blood clots, stiffness of the joint, injuries to vessels and nerves and problems with healing.
It’s important to contact Adrian or your own GP as soon as possible if:

• You have pain that becomes worse – lasting for more than a few days – in the knee joint
• You have a temperature and/or feel unwell – this could mean you have an infection
• Your knee joint is very inflamed, swollen or the wound is bleeding/oozing
• You have extreme discomfort in your lower leg (this can be a sign of DVT)

After your operation, you’re likely to stay in hospital for two to three days. You’ll need to use crutches and, in some cases, wear a knee brace for four to six weeks after surgery to protect your knee while the bone is healing.

You’ll be encouraged to begin some exercises straight away as part of your rehabilitation plan; these will help to maintain the range of motion and restore strength in the knee joint. Adrian will be able to advise you about the type of activities you can do after surgery and how to build up your fitness so that you can return to normal levels of exercise as soon as possible. In most cases, you’ll be able to drive again around four to six weeks after surgery.