Osteotomy

Background

Osteotomy (o-stee-o-tuh-mee) is a procedure performed to correct or alter the shape of the limb in order to unload the painful area and delay the need for joint replacement surgery. Osteotomy can be performed either above (thigh bone) or below (shin bone) the knee. Osteotomy is considered where there is localised pain and early arthritis compared to more generalised disease.

Indications

Osteotomy is considered in the patient where a joint replacement is unlikely to be successful. Typically these patients are younger and more active and commonly have suffered an injury or undergone previous surgery (i.e. partial meniscus removal). The goal of an osteotomy is to off-load the worn and painful area and shift the pressure to the opposite side. There are strict requirements when considering patient suitability for osteotomy surgery and Dr Anderson will discuss these with you at the time of consultation if appropriate.

Treatment/Pathology

Osteotomy is reserved for cases where other treatment have not been successful including physiotherapy, activity modification and injections. Dr Anderson will discuss the role of an off-loading brace on the affected knee. The purpose of this is to unload the affected area and decrease pain while also simulating what an osteotomy would feel like. Careful planning is required when considering an osteotomy including a detailed medical and knee history, a focused examination to ensure suitability and medical imaging. Dedicated planning scans are required to assess your exisiting deformity and plan the necessary correction.

Surgical Detail

Knee osteotomy involves the controlled and deliberate surgical breaking of the bone to allow the necessary correction which is then secured with specially designed plates and screws. The type of osteotomy that is chosen depends on the underlying condition and these are approached in a specific way. Sometimes an osteotomy is combined with additional procedures to address instability and other soft tissue deficiencies around the knee. The surgery is performed under general anaesthetic through an incision above or below the knee specific to the type of osteotomy being performed. X-ray guidance is used to ensure the planned correction is achieved. A surgical drain is commonly placed to help reduce the risk of bleeding into the leg that would otherwise cause tight swelling and pain. The knee is immobilised in a brace or splint for comfort and to protect the osteotomy.

Post-Operative/Recovery

Patients typically spend 2-3 nights in hospital to monitor their pain and swelling. A period of protected weight-bearing is required after an osteotomy while the bone is healing. A physiotherapist will meet you the following day to commence your rehabilitation before being reviewed by Dr Anderson. Your 2-week review involves a wound check and a chance to monitor your recovery. An X-ray is performed 6 weeks after surgery to assess for bone healing.

Key Points

• Localised knee pain

• Young/Active patients with early arthritis

• Correction to unload painful area