Knee osteotomy

Overview  

There are two types of osteotomy: opening wedge and closing wedge. A knee osteotomy is a surgical procedure used to treat pain and instability caused by knee joint damage or arthritis in a specific area. Instead of opting for a complete knee replacement, doctors may recommend an osteotomy when only a particular part of the knee is affected. 

During the surgery, the surgeon adjusts the position of either the tibia (shin bone) or femur (thigh bone) to realign the knee. This redistribution of body weight shifts the load away from the damaged area to a healthier portion. 

Knee osteotomy can help slow down the deterioration of cartilage in the knee, potentially delaying the necessity for knee replacement surgery for a substantial period. This technique has been utilized for decades to improve pain relief and enhance functional improvement.

Types of knee osteotomy 

The two main types of osteotomy are opening wedge and closing wedge. 

• Opening wedge osteotomy: Involves the occasional use of a graft to preserve the space between the ends of the osteotomy gap. 
• Closing wedge osteotomy: Entails the surgeon cutting a wedge of bone from the leg and then bringing the sides of the gap together to close the space. 

Reason for undergoing the procedure  

Within all joints, including the knees, exists a cushioning tissue known as cartilage, where bones meet. In certain individuals, the erosion of this cartilage in a joint leads to a condition called osteoarthritis, resulting in discomforting friction between the tibia and femur. Consequently, this friction gives rise to knee pain and stiffness. Doctors perform knee osteotomy to alleviate pressure from the compromised knee area and redistribute it to an area with healthy cartilage and cushioning. This surgical adjustment aims to alleviate pain and enhance knee mobility. Additionally, doctors can also use knee osteotomy to correct improperly healed broken knees. 

Risks  

Although they are uncommon, knee osteotomy complications can include:  

• Blood clots  
• Infection  
• Damage to nearby blood vessels and nerves  
• The osteotomy’s failure to heal or its delayed recovery  
• Acute discomfort from implanted hardware or hardware failure  

Procedure  

A knee osteotomy procedure involves making changes to the bone alignment in your knee to alleviate certain conditions. To carry out this surgery, your doctor will recommend suitable anesthesia options: 

• General anesthesia: This involves administering medications that induce a sleep–like state throughout the surgery. 
• Spinal anesthesia: An injection in your back will numb the lower part of your body, typically from the waist down. 

To maintain the corrected bone position during the healing process, your doctor can choose from different methods, including using metal screws and a plate or a biocomposite material. The surgery itself usually lasts around one to two hours. 

Once the knee osteotomy is complete, close monitoring will be conducted as you recover from the anesthesia. Patients generally stay in the hospital for one to two days after the surgery, although some might even be discharged on the same day. While your knee heals, you’ll likely need to rely on crutches or a walker for a few weeks to prevent putting excessive weight on the healing knee. 

Outcome  

Knee osteotomy commonly brings pain relief and improved knee function, leading to enhanced quality of life. After healing, individuals typically experience unrestricted physical activity, with most returning to their regular routines within three to six months post–surgery.