Osteotomy of the knee

What is osteotomy surgery?

Osteotomy of the knee is a type of knee surgery. It involves making a cut in one of the leg bones in your lower limb. This can realign the leg and relieve symptoms of arthritis for some people.

  • The surgery is called a tibial osteotomy if the cut is being made on the shin bone.
  • The surgery is called a femoral osteotomy if the cut is being made on the thigh bone.

Reasons to do knee osteotomy

Arthritis most often affects the inside of the knee. This is because the inside of the knee bears more of a person's weight when walking and standing. Some people do wear the outside part of the knee out, but this occurs less often. Arthritis can develop in young people, especially after injury or surgery.

Knee replacement surgery may not be the best option for some people. When a knee replacement is done, the artificial knee may wear out over time. This is more likely to occur in younger people or those who are very active.

If a second knee replacement is needed in the future, it may not work as well as the first one.

An osteotomy may delay the need for you to have a knee replacement for up to 10 years, while allowing you to stay active.

Osteotomy surgery does this by shifting your weight away from the damaged part of your knee to the other side of the knee when you're standing. To be successful, the side of the knee where the weight is being shifted should have little or no arthritis.

What happens during knee osteotomy?

During surgery:

  • You will be pain-free during surgery. Spinal or epidural anesthesia, along with medicine to help you relax, may be used. You may also receive general anesthesia, where you will be asleep.
  • Your surgeon will make a 4- to 5-inch surgical cut (incision) on the area where the osteotomy is being made. If this is a tibial osteotomy (lower-leg bone), it is made below the knee cap. If it is a femoral osteotomy (thigh bone), the incision is placed above the knee cap.
  • In a closing wedge osteotomy, the surgeon may remove a wedge of your shinbone from underneath the healthy side of your knee.
  • In an opening wedge osteotomy, the surgeon will make a cut in the bone on the painful side of the knee and put a wedge in there to open up the cut.
  • Staples, screws, or plates may be used, depending on the type of osteotomy.
  • A bone graft may be needed to fill out the wedge.

The procedure usually takes 1 to 1 1/2 hours to perform.

A tibial osteotomy results in a slightly "knock kneed" appearance. A femoral osteotomy results in a "bow legged" appearance.

What happens after knee osteotomy?

Your doctor may fit you with a brace to limit how much you are able to move your knee as you recover. The brace may also help hold your knee in the correct position.

You will likely need to use crutches for 6 weeks or more. At first, you may be asked not to place any weight on your knee at all. Your doctor will tell you how to slowly put weight on your leg, and this can allow the osteotomy to heal.

You will see a physical therapist to help you with an exercise program.

Complete recovery may take several months to a year.

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Review Date: 8/9/2018

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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