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Joint Preservation / Osteotomy Surgery

Knee osteoarthritis can develop due to underlying problems with leg alignment. Osteotomy surgery aims to realign the leg and offload the forces from the arthritic part of the joint to the healthy part of the knee joint.

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The back of a man's legs as he runs in the rain following osteotomy surgery

Knee osteoarthritis can develop due to underlying problems with leg alignment. There are 3 different types of leg alignment:

·     Varus (bow legged)

·     Neutral (straight)

·     Valgus (knock kneed)            

 

In varus and valgus knees, the body weight and forces are acting excessively in one compartment or the other. In varus knees, the forces pass through the medial compartment and in valgus knees, the forces passthrough the lateral compartment.

This leads to excessive wear and damage to cartilage in one part of the knee joint only, meaning that the rest of the joint remains relatively spared.

Osteotomy surgery aims to realign the leg and offload the forces from the arthritic part of the joint to the healthy part of the knee joint.

This means that knee replacement surgery can be avoided fora significant period of time and the native knee joint preserved.

This is a particularly beneficial solution for younger patients with knee OA and once the alignment is corrected, the progression of osteoarthritis can be avoided in some cases.

Assessment

A physical examination and thorough history are required as well as routine knee x-rays.

A long leg alignment x-ray is also carried out. This allows us to calculate the various angles, work out where the deformity exists, and plan the corrective surgery.

 An MRI scan may also be necessary to check the health of the rest of the knee to confirm eligibility for the surgery and to exclude any other major pathology.

Surgery

There are two types of osteotomy surgery - high tibial osteotomy and distal femoral osteotomy. Learn more about each of these below.

High Tibial Osteotomy

This is the commonest osteotomy operation performed, usually for varus knees with medial compartment OA.

Once the angles and the correction have been calculated, an incision is made over the top end of the shin bone (tibia) and the bone exposed. An incision is then made in the bone from the medial side of the tibia towards the lateral cortex of the bone. Care is taken to preserve the lateral cortex and the osteotomy site is gently opened which gradually corrects the axis of the bone to the desired point.

This is then carefully held in position and a strong plate applied to hold the bone in place.

This results in the body weight forces passing through the healthy part of the knee joint and therefore eliminating the pain.

Distal Femoral Osteotomy

This is less commonly performed and is usually for valgus knees with OA in the lateral compartment.

 After careful planning, an incision is made on either the inside of the thigh or the outside of the thigh, just above the knee. The distal end of the femur is exposed, and an incision made in the bone. The desired correction is achieved, and a strong plate applied to hold the correction in place.

This results in the body weight forces passing through the healthy part of the knee joint and therefore eliminating the pain.

Getting Started

Learn what to expect at your appointment.

Learn more about what to expect at your consultation with Mr Bilal Barkatali.
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