In some people with arthritis of the knee that are considering further surgery, it is possible to keep their knee joint by realigning the leg so that the bad part of the knee is offloaded. This involves surgically breaking the tibia or the femur bone. Although this sounds very drastic, if successful, it can delay the need for a knee replacement for many years, and allows unlimited activity (unlike a TKR). Hence it is particularly useful for younger, patients, especially if they wish to return to significant sport or high activity.
For this operation to be successful, the knee needs to have nearly normal range of movement, and have arthritis limited to one side of the knee only. I assess suitability for this with an examination and an arthroscopy of the knee. The surgical fracture (osteotomy) is usually carried out on the inner aspect of the tibia (shin bone) and is then known as a high tibial osteotomy.
(Fig 1) If done on the femur, the osteotomy is usually carried out on the outer aspect of the femur bone and is known as a distal femoral osteotomy.
(Fig 2) The bone is fixed with a plate. The patient is mobilized straight away and usually goes home on the second day, on crutches. It takes at least 3 months before these patients can get back to full activity. Complications are surprisingly rare but include infection, DVT/PE, nerve injury, non-healing osteotomy.
Overall, the average osteotomy lasts more than 7 years before further surgery is required (other than removal of the plate).
Fig 1. X-Ray of a high tibial osteotomy.
Fig. 2. X-Ray of a distal femoral osteotomy
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