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Knee Osteotomy
Dr. Ambrose Yung
What is a Knee Osteotomy?
A knee osteotomy is a surgical procedure that involves cutting and realigning the bones in the knee joint to relieve pressure on the damaged area. It is primarily used to treat knee osteoarthritis when the wear and tear are more pronounced on one side of the knee.
By shifting the body weight onto the healthier side of the knee, the surgery aims to reduce pain and improve joint function. Knee osteotomy is commonly recommended for younger, active individuals who wish to delay total knee replacement.
Indications for Knee Osteotomy
Knee osteotomy can relieve pain, improve mobility, and delay the need for knee replacement in the following cases:
Unilateral Knee Osteoarthritis
Knee osteotomy is ideal for patients with osteoarthritis that affects only one side of the knee, which causes pain and reduced mobility. It helps redistribute weight away from the damaged area.
Knee Malalignment (Varus or Valgus Deformity)
Patients with bow-legged (varus) or knock-kneed (valgus) deformities that cause uneven wear on the knee joint are suitable candidates for osteotomy. The procedure realigns the bones to relieve stress on the affected side of the knee.
Active Individuals Seeking to Preserve Mobility
Knee osteotomy is often recommended for physically active individuals who wish to maintain or improve their mobility without undergoing total knee replacement. It allows them to continue engaging in physical activities by relieving pain and restoring proper function to the knee.
Benefits of Knee Osteotomy
- Reduces Knee Pain: By redistributing weight away from the damaged area, knee osteotomy helps reduce pain caused by uneven wear on the knee joint.
- Improves Mobility: Patients often regain knee function and mobility after recovery, allowing them to resume daily activities or sports without discomfort.
- Prolongs Knee Joint Life: Knee osteotomy helps slow down the progression of osteoarthritis, preserving the natural knee joint for a longer period. The procedure can extend the lifespan of the knee joint by up to 10 to 15 years.
Types of Knee Osteotomy
There are two main types of knee osteotomies, each addressing different areas of the knee and specific deformities:
High Tibial Osteotomy
This procedure focuses on the tibia (shinbone) and is commonly used to treat bow-legged (varus) deformities. The tibia is cut and realigned to shift weight away from the inner part of the knee, relieving pressure on the damaged cartilage. It is most effective for patients with medial (inner) knee osteoarthritis.
Distal Femoral Osteotomy
This procedure involves the femur (thighbone) and is typically performed to correct knock-kneed (valgus) deformities. The femur is reshaped to shift weight away from the outer part of the knee. It is often recommended for patients with lateral (outer) knee osteoarthritis.
Preparation for Surgery
Before undergoing knee osteotomy, proper preparation is necessary for a successful outcome. Here are several important steps to take:
- Medical Evaluation: A thorough medical evaluation, including X-rays or MRI scans, is required to assess the extent of knee damage. Blood tests may also be performed to ensure the patient is suitable for surgery.
- Pre-operative Instructions: Patients are typically instructed to discontinue certain medications like blood thinners several days before surgery.
- Fasting Before Surgery: Patients are advised to fast for at least 6 hours before the procedure, which helps reduce complications during anaesthesia.
Step-by-Step Procedure
Anaesthesia
General or spinal anaesthesia is administered to ensure the patient is pain-free during the procedure. The type of anaesthesia used depends on the patient’s health and the surgeon’s recommendation.
Incision and Bone Realignment
The surgeon makes an incision over the knee and cuts either the tibia or femur. A wedge-shaped section of bone is adjusted to realign the knee and shift weight away from the damaged area.
Fixation
After realigning the bone, the surgeon uses metal plates, screws, or pins to stabilise the bone in its new position, allowing it to heal correctly.
Completion
Once the bone is stabilised, the incision is closed with stitches or staples, and the knee is bandaged.
Post-Surgical Care and Recovery
- Immediate Care: After surgery, the patient is monitored for several hours to ensure there are no immediate complications. Pain is managed with medication, and ice packs may be applied to reduce swelling.
- Recovery Process: Recovery can take 6 to 12 months, during which physiotherapy is required. The patient will initially use crutches to avoid weight-bearing on the knee and will gradually increase activity as the bone heals.
- Follow-Up: Follow-up appointments are necessary to monitor healing, with X-rays taken to ensure the bone is healing in its new position. Additional physiotherapy may be prescribed to aid in full recovery.
Risks of Knee Osteotomy
As with any surgery, knee osteotomy carries risks that patients should be aware of. These include:
- Infection: There is a risk of infection at the incision site, which may require antibiotics or, in severe cases, further surgical intervention. Proper wound care and hygiene help mitigate this risk.
- Blood Clots: Blood clots may form in the legs after surgery, which can be serious if they travel to the lungs or other parts of the body. Treatment often includes blood-thinning medications.
- Nerve or Blood Vessel Damage: There is a small chance of injury to the nerves or blood vessels around the knee during surgery, which could lead to numbness, weakness, or poor circulation.
- Delayed or Incomplete Bone Healing: In some cases, the bone may heal at a slower rate or may not heal properly. This may require additional treatments or, in rare cases, another surgery.
Our Clinic Locations
Spire Hip & Knee Centre
6 Napier Road #08-04
Singapore 258499
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
Spire Orthopaedic Physiotherapy & Rehab Centre
101 Irrawaddy Road, #18-03
Singapore 329565
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
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Frequently Asked Questions (FAQ)
How soon can I return to work or daily activities?
The timeline for returning to work or daily activities depends on the nature of your job and how quickly your knee heals. Office workers may return in 4-6 weeks, while those with physically demanding jobs may require several months before resuming work.
Are there any restrictions after knee osteotomy?
Yes, you may need to avoid high-impact activities that put excessive stress on your knee, such as running or heavy lifting, to preserve the benefits of the surgery and protect the joint from further damage.
Will I need a knee replacement eventually?
In some cases, patients may still need a total knee replacement later in life, especially if osteoarthritis progresses to other parts of the knee. However, osteotomy can delay this need for many years.