What is this procedure?

These pictures show before and after a proximal tibial osteotomy, where the tibia has been refashioned below the knee joint to relieve pressure on the inside (medial) aspect of the knee.

Osteotomy refers to an operation where a bone is cut and refashioned, to correct the alignment of the bone or to shift weight from arthritic cartilage to healthy cartilage. Sometimes a wedge of bone is removed (closing wedge osteotomy) or sometimes a piece of bone is harvested from elsewhere to use as graft. In either case a plate and screws are used to hold the position of the bone until it has healed.

In a high tibial osteotomy the shin bone (tibia) is cut and refashioned just below the knee joint. It is used for when there is arthritis on the inner (medial) side of the knee joint in people who are bow-legged (varus knee joint).

In a distal femoral osteotomy, the thigh bone (femur) is cut and refashioned just above the knee. It is used for when there is arthritis on the outer (lateral) side of the knee joint in people who are knocked knees (valgus knee joint).

Who should consider this operation?

Knee re-alignment osteotomy is beneficial in individuals whose leg alignment is contributing to pain and who have early arthritis affecting just part of the knee joint. Osteotomy is particularly good if you are a very active, younger adult who wishes to delay having a knee replacement.

Preoperative preparation and evaluation

These pictures show before and after a distal femoral osteotomy, where the femur has been refashioned above the knee joint to relieve pressure on the outer (lateral) aspect of the knee.

The surgeon will need to take a history and examine the lower limbs. If there is a fixed flexion contracture of more than 10 degrees (the knee does not straighten fully) then osteotomy is not appropriate. The skin and soft tissues will be evaluated and smokers may be required to quit, as good healing is required for osteotomy to be successful. Imaging of the whole leg is required to measure alignment. This can include standing Xrays or CT scanning. Arthroscopy or MRI scanning may also be required to rule out other causes of symptoms.

What happens in the post-operative period?

For the first six weeks usually you are only allowed to toe-touch weight bear, with most of the body weight being taken by crutches or a frame. It is important that the range of movement in the knee is maintained and physiotherapy will focus on this from the start. When the physiotherapy goals are achieved and the wound appearance is satisfactory you will be allowed home. The length of hospital stay varies from individual to individual but discharge occurs typically on the second or third day post operatively.

High Tibial Osteotomy

The video below shows a detailed explanation of the causes and presentation of High Tibial Osteotomy. They show a basic outline of the procedures used by Amir Qureshi and after care required in order that you, the patient, may recover to your full fitness once again.