Corrective osteotomy (of the upper part of the tibia or the lower part of the thigh bone) is a surgical method reserved for the treatment of moderate osteoarthritis of the knee which allows patients a high level of activity.

The word 'osteotomy' literally means "to cut or cut a bone". Osteotomy in the knee area is used in the earlier stages of osteoarthritis, when only one side of the knee joint is damaged. The procedure involves removing or adding a wedge of bone to the lower leg (shin bone) or thigh bone (femur) to shift body weight off the damaged part of the knee joint. By transferring the load from the damaged to the healthy side of the joint, osteotomy can relieve pain and improve the function of the knee affected by arthritis.

Knee osteotomy is most often performed in people younger than 60 who are physically active. Many people who undergo this procedure for arthritis may need a total knee replacement—usually about 10 to 15 years after the knee osteotomy.

That's why it's important to start on time with the examinations and alleviate the complaints.

Why is it performed?

In a healthy knee, when walking or standing, the load is transferred through the middle of the knee joint. If the normal anatomical relationships are disturbed for any reason (varus and valgus deformities), increased wear occurs on the inner (medial) or outer (lateral) side of the knee. Some patients have deformities visible to the naked eye in terms of "O" or "X" legs. The reconstruction of normal biomechanical relations by corrective osteotomy of the femur or lower leg contributes to the relief of the damaged part, restores the normal function of the joint and delays the installation of a total endoprosthesis.

Indications

• a young, active patient (<60 years) in whom arthroplasty would not succeed due to excessive wear
• knee valgus or varus
• a healthy person with a good vascular status
• patients with a moderate physique (BMI <35)
• pain and disability that interfere with daily life
• involvement of only one section of the knee
• a cooperative patient who will be able to follow the protocol

General contraindications

• inflammatory arthritis
• obese people (BMI> 35)
• flexion contracture (> 15 degrees)
• incomplete knee flexion (<90 degrees)
• >20 degrees of necessary correction
• patellofemoral arthritis
• ligament instability
• "varus thrust" during walking
• uncooperative patient

Risks

Risks of corrective osteotomy surgery in the knee area may include:

• infection in the bone or in the surrounding soft tissues
• failure to join bone parts
• nerve injuries or vascular trauma around the knee
• thromboembolism
• incomplete pain relief

What to expect?

Before surgery

What can you do before seeing an orthopedic surgeon?

• Imaging studies (magnetic resonance (MR) of the painful knee )
• Prepare answers to the orthopedic surgeon's questions that include:
  • List the symptoms, how long do they last, when did they start?
  • On a scale from 0 to 10, how much does it hurt you at rest, and how much during exercise?
  • Are there activities that increase the pain? Do you have pain at night?
  • Have you had any knee injuries so far?
  • Do you take any medications or nutritional supplements?
  • Do you have any other medical problems?
• Prepare questions for the orthopedist

Orthopedic specialist examination

In order to establish an indication for a corrective osteotomy in the knee area, an orthopedic specialist will determine the range of motion and stability of your knee through a clinical examination. For the indication, radiological images (X-rays) of the knee joint are also necessary, which should preferably be done before the examination. The orthopedic specialist will decide on any additional imaging studies (panoramic X-ray of the lower extremities) required for additional preoperative planning following the clinical examination.

After the patient makes a decision about the surgical procedure, he arranges the date of the operation and receives all the necessary information needed for quality preoperative preparation. The patient receives instructions on the necessary laboratory and diagnostic tests that must be performed before the scheduled surgery, and which must not be older than 30 days.

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Anesthesiology examination
After setting the indication and agreeing on the date of the operation, it is necessary to have an examination by an anesthesiologist who will decide on the type of anesthesia. The patient fills in the "Questionnaire before anesthesia" in which they enter information about their current state of health, possible allergies and medications they may be taking. Based on these data, the anesthesiologist makes a decision on possibly necessary additional specialist examinations and diagnostic or laboratory tests.

Arrival at the hospital
Upon arrival at the hospital, the patient is placed in a room and receives informed consent with all relevant information related to the surgical procedure. He signs it and the patient is prepared for the operation. Every patient is given an antibiotic before, during and after surgery to prevent post-operative infections.

During surgery
Before the surgery, it is necessary to do precise preoperative planning, which includes determining the osteotomy site and the angle of correction. Depending on the location of the damage, surgery may involve your lower leg or femur. The most common form of knee osteotomy involves the lower leg. Corrective osteotomies in the knee area can be:

• opening-wedge osteotomy
• closing-wedge osteotomy

Opening-wedge osteotomy is an operation that consists in cutting the femoral or lower leg bone, the bone is "opened" in the shape of a wedge (the degree of opening is determined by preoperative planning) and then fixed in the desired position with a plate and screws. The cavity in the bone created by the operation is filled with bone tissue over time, and in some cases it can be filled with an "artificial bone" preparation.

Another option is to cut the lower leg or thigh bone and then remove the bone wedge. The cut edges of the bone are joined and fixed with a plate and screws. This is called a closing-wedge osteotomy.

At the end of surgery, the cut tissues are sewn up in layers and the skin is closed with stitches. The operation itself lasts 1 to 2 hours. After the operation, the sutured wound is covered with plaster and bandages, and the patient is transferred to the ward.

During surgery, the patient is under general or spinal anesthesia, which is decided by the anesthesiologist. In general anesthesia, the patient is unconscious and wakes up after the operation. In spinal anesthesia, on the other hand, the patient is awake but does not feel pain from the waist down.

A gradual increase in load after surgery has a beneficial effect on the bone healing process. It is believed that full bone healing (depending on the location and size of the correction) takes 6-8 weeks.

After surgery

After the operation, the patient is transferred to the ward, where he stays in the room for several (2-3) days. Pain management after surgery will be taken care of by our anesthesiologists. During your stay in the hospital, our doctors and nurses will take care of dressing the surgical wound, while our physiotherapists will perform physical therapy in order to increase the range of motion in the operated knee as soon as possible, but also to teach you after the operation how to perform certain movements such as walking with crutches and climbing and descending stairs.

It starts with stretching the knees, and special emphasis is placed on strengthening the hamstring muscles. After leaving the hospital, it is advisable to continue rehabilitation in our Center for physical medicine & rehabilitation. In order to ensure the fastest and highest quality recovery, it is important to follow the instructions on dressing the wound, diet, physical activity, etc.

You will need to use crutches for about two months to allow your bone to heal properly. Until the first control examination and X-ray control (6 weeks after surgery), it is mandatory to walk with two forearm crutches and impose partial weight bearing on the operated leg. After that, it is allowed to discard one crutch and gradually increase the load on the operated leg, which has a positive effect on the bone healing process. Discarding the second crutch is recommended when the patient feels satisfactory safety and stability of the operated leg, and usually occurs within the next 4 weeks. Rehabilitation can last up to six months. Exercises are important during rehabilitation:

• strengthening of thigh muscles (quadriceps)
• increasing the range of motion of the knee
• improving balance

Control examinations, their frequency and additional postoperative radiological scans will be indicated by the operator, and in most cases the next controls are 3, 6 and 12 months after the operation.

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Results

In most cases, knee osteotomy relieves arthritis pain and delays the need for total knee replacement by 10 to 15 years.

St. Catherine is one of the hospitals in this part of Europe that, in one place, with a multidisciplinary approach and using the most modern equipment, provides top diagnostics, the best therapeutic and surgical procedures and individually prepared rehabilitation, which sets it apart from other hospitals.  Corrective osteotomy surgery in our Hospital is a routine procedure that we do every day.

See for yourself why St. Catherine is the best choice and book an appointment.