Lower limb osteotomy
As the disease process advances, the cartilage on the inner side wears away. This, often in combination with a tear in the meniscus (cartilage shock absorber) leads to pain on the inner aspect of the joint. This also leads to a change in alignment of the leg. If you look in the mirror, you may notice that your knees have become more ‘bandy’ or ‘bow legged’.
This makes the situation worse as rather than spreading your weight evenly throughout the knee when you walk, the weight is concentrated in the diseased area of the joint.
Osteotomy is an operation that ‘re-aligns’ your leg so that the weight is redistributed through the normal side of your knee.
Who is suitable?
What are the benefits?
Studies have shown that it delays the need for knee replacement by 9 years. It is important to understand that because the arthritic side of the joint is not removed but simply un-loaded, some ongoing symptoms from the knee can be experienced. Overall a reduction in pain of 70–80% can be expected.
What are the alternatives?
How is the surgery done?
Once the desired correction has been made, a plate with screws is used to stabilise the bone. X-rays are used during the operation to confirm the alignment of the leg. the Sometimes bone graft is placed into the gap.
What are the risks?
- Infection and wound problems which may require further surgery or antibiotics.
- Blood clots in the calf or lung can occur and often medicine will be used to help prevent this.
- Rarely there can be damage to nerves and blood vessels or ligaments around the knee.
- Occasionally there may be a delay in the bone healing.
- Sometimes the plate and screws can be irritating under the skin and require removal but only once the bone has healed.
- Over many years the rest of the knee may wear out and conversion to a knee replacement may be required in the future.
What about recovery?
It is important to keep the dressing intact and dry until the wound is healed. Once the wound is healed it is good to get in the pool. Physiotherapy will help with further recovery. Driving is possible after around 6–8 weeks.
X-rays will be taken periodically until the bone heals.
Return to work in an office type job can be between 3–6 weeks. A manual job requires 8–12 weeks before returning to work. Overall recovery can be expected between 3 and 6 months but rarely it can take a year for the bone to fully heal.
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