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Knee Osteotomy

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Knee Osteotomy

(Osteotomy, Knee)

Definition

A knee osteotomy is the removal of a wedge of bone from the tibia to realign the leg. The tibia is the shinbone. Recovery time will depend on certain factors, such as your overall health.
The Kneecap
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Reasons for Procedure

This procedure aligns the knee joint so the healthy part of the knee surface is able to do more weight-bearing. This takes pressure off the damaged part. Damage is often due to osteoarthritis. This surgery may be done instead of a total knee replacement.
While osteotomy does not cure conditions like osteoarthritis, the surgery may:
  • Reduce pain
  • Improve movement
  • Delay further damage to the joint
  • Postpone the need for total knee replacement surgery

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Infection
  • Excess bleeding
  • Swelling
  • Blood clots
  • Shortening of the leg
  • Injuries to nerves or blood vessels
Factors that may increase the risk of complications include:
  • Smoking
  • Poor nutrition
  • History of blood clots
  • Long-term illness
  • Use of certain medications

What to Expect

Prior to Procedure

Prior to the surgery, the doctor will order tests to confirm the diagnosis and decide how much bone to remove.
Tests may include:
Before surgery, you will need to:
  • Arrange for a ride home.
  • Arrange for help at home while you recover.
  • Talk to your doctor about any allergies you have.
  • Ask your doctor about assisted devices you will need.
  • If you are overweight, lose weight. This will help to decrease the amount of stress on your new joint.
  • Install safety equipment in the bathroom, shower, and on the stairs.
  • Prepare a bedroom on the first floor if possible. Climbing stairs will be difficult at first.
Talk to your doctor about any medications, herbs, or supplements you are taking. You may be asked to stop taking some medications up to one week before the procedure, like:
  • Aspirin and other anti-inflammatory drugs
  • Blood-thinning drugs, such as warfarin
  • Anti-platelet drugs, such as clopidogrel
Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Anesthesia

Anesthesia will keep you pain-free and comfortable during the procedure. Anesthesia methods include:

Description of the Procedure

There are many methods that can be used to perform an osteotomy. In one method, the doctor uses imaging technology to measure the piece of bone that will be removed. A cut is made in the skin from the knee cap to the top of the shinbone. Several thin wires are placed in the knee to serve as guides, showing where the bone should be cut. The doctor uses an oscillating saw to remove the bone wedge. The remaining parts of the bone will be held together with staples, screws, or a plate and screws. The doctor will stitch the tissue together and close the area.

How Long Will It Take?

1-3 hours

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

Average Hospital Stay

You may need to stay in the hospital for 2-3 days. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Hospital
Right after the procedure, you will be taken to recovery and monitored closely. The staff may give you:
  • Pain medication
  • Antibiotics to prevent infection
  • Medication that prevents blood clots
  • Place padded bandages over the incision sites
  • Apply ice to reduce swelling
  • A splint or brace to hold the knee in the right position
At Home
To help ensure a smooth recovery at home, take these steps:
  • Apply ice or a cold pack to the area for 15-20 minutes four times a day. Wrap the ice in a towel. Do not apply it directly to your skin.
  • Elevate the injured leg to reduce swelling.
  • If you have a cast, follow the doctor’s instructions for taking care of your skin.
  • Use crutches or a walker. Avoid putting weight on your injured leg until your doctor gives you permission.
  • Keep the incision area clean and dry.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water. Place a plastic covering over the incision areas if your doctor recommends keeping it dry.
  • Start working with a physical therapist once you are instructed to. The therapist will focus on balance, range-of-motion, and strength training.
  • Maintain a healthy weight after surgery.
  • Follow your doctor's instructions.
You will need to return to the doctor to have your cast removed or to have x-rays taken. Full recovery can take six months.

Call Your Doctor

Call your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Swelling, redness, or pain in your legs, calves, or feet
  • Pain that you cannot control with the medications you have been given
  • Nausea and vomiting
  • Cough, shortness of breath, or chest pain
  • Your leg, foot, or toes appear chalky white, blue, or black
  • Numbness or tingling in your leg, foot, or toes
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
If you think you have an emergency, call for medical help right away.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.org

American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Degenerative joint disease of the knee. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 3, 2013. Accessed May 6, 2013.

Frequently asked questions: high tibial osteotomy. New England Musculoskeletal Institute website. Available at: http://nemsi.uchc.edu/clinical%5Fservices/orthopaedic/sportsmedicine/faqs/faqs%5Fhto.html. Accessed May 6, 2013.

Knee osteotomy. The Knee Society website. Available at: http://www.kneesociety.org/web/patienteducation%5Fosteo.html. Accessed May 6, 2013.

Knee replacement surgery. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/orthopaedic/knee%5Freplacement%5Fsurgery%5Fprocedure%5F92,P07673/. Accessed May 6, 2013.

Marti R, Verhagen R, Kerkhoffs G, Moojen T. Proximal tibial varus osteotomy. J Bone Joint Surg Am. 2001;83-A(2):164-170

Wilson A. Knee osteotomy and painful osteoarthritis. Knee Guru Information Hub website. Available at: http://www.kneeguru.co.uk/KNEEnotes/node/2153. Published May 13, 2010. Accessed May 6, 2013.

6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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