What to Expect

As with many types of modern surgery, most of the time and work involved takes place outside the operating theatre. The surgery itself varies from 1-2 hours depending on the complexity and you can expect to stay in hospital for 2-3 days afterwards.

Before Surgery – Planning and Preparation

The journey towards osteotomy surgery begins with a detailed assessment to discover if the damage to your knee is treatable using this technique. An X-ray of both your legs will be taken from your hips to your ankles. Specially designed software works out exactly which bone to cut and by how much to realign your knee joint.

As you can see from this snapshot, the software is used to find the correct line of realignment.

Using the information from X-rays and scans, the software can then show the surgeon whether the problems lie within the tibia or femur, or both, and where the cuts need to be made.

Having a High Tibial Osteotomy

In this form of osteotomy, a cut is made in the top of the tibia, within a few centimetres of the knee. A surgical instrument is used to widen this cut into a pie-shaped wedge.

You can see this being done in the images above. On the left, the cut in the bone has been made and the opening instrument is being introduced. In the picture on the right, the osteotomy has been opened to the correct angle.

The next step is to fix the opening in place so that the bones remain in alignment. A strong plate (usually a Tomofix or Peek Power plate )is screwed in place into the bone to hold the wedge securely.

The screws holding the plate in place extend most of the way through the bone.

The incisions are then closed and the operation is concluded.

Having a Distal Femoral Osteotomy

This procedure is similar in terms of planning but the cut in the bone is made in the lower end of the femur (the thigh bone).

The thigh bone is a much larger bone which is under greater strain and so the operation is typically performed with a wedge of bone removed from the inside of the thigh bone.

The gap created is then closed and held rigidly with a strong plate. This has exactly the same effect on correcting the alignment of the bones but the closure of the wedge provides much greater stability after surgery.

The two faces of bone that meet together are fixed by the plate but heal together after surgery, becoming one intact bone.

Before and After an Osteotomy

The success of any surgery depends partly on how well you, the patient, prepare for surgery and how well you rehabilitate afterwards.

The video on the right shows the typical level of recovery after 6 weeks.

You can do several key things to help ensure your surgery and your recovery after osteotomy goes just as well.

Preparing for an Osteotomy

After you have had all your imaging done and you are given a date for surgery it is important to follow the pre-surgery advice:

  • If you smoke, you must stop at least two weeks before the operation. You must then not smoke for at least 3 months.

Why? The toxins in smoke change the way blood flows through the bones and this can have a very negative effect on healing. If you smoke, you are more at risk of infection, poor healing and other complications.

  • Follow instructions on how to take any medication in the week before your surgery, the day of surgery and the first few days afterwards. This is particularly important if you are taking drugs to prevent stroke (such as warfarin or dabigatran).

Why? These drugs inhibit blood clotting and you may need to stop taking them under supervision from your surgeon to avoid bleeding during surgery.

  • Follow instructions about fasting and drinking the day before the operation and on the morning of surgery.

Why? An osteotomy is always performed under a general anaesthetic and you need to have an empty stomach so that you do not vomit.

  • Think about using a muscle stimulator to improve your muscle bulk and function prior to surgery. This can be continued for 8-12 weeks after your operation.

Why? The stronger and bulkier your muscles are, the faster your bones will heal and the more mobile you will be during your recovery.

Your surgeon will also advise you about the level of activity you can safely do while you are waiting for surgery.

Immediately after your Osteotomy

At the end of your surgery, your surgeon will introduce a large amount of local anaesthetic into your knee joint and into the tissues surrounding the osteotomy site to relieve pain as soon as you wake up.

Once you have come round from the anaesthetic you will be encouraged to become mobile within a few hours. This will help get your blood flowing and will lower the risk of deep vein thrombosis.

It will also ease any stiffness. Mobility after any form of surgery is beneficial but after a high tibial osteotomy, it is important that you start moving your knee joint from day one.

You will be given pain relief as you need it in the first 48 hours. Once you return home over-the-counter pain relief should help you through the next few days. Its important to avoid anti-inflammatory tablets after osteotomy surgery.

If you have had a femoral osteotomy, you will need to use crutches and perhaps wear a knee brace for four-six weeks. This will protect your knee until the bone has healed.

Signs of possible complications after Surgery

Complications occur after an osteotomy in a small minority of patients. However, it is important to know what to worry about and when to contact your surgeon or hospital:

If you experience worsening pain in your knee joint that lasts more than a few days.

  • If you experience worsening pain in your knee joint that lasts more than a few days.
  • If you develop a fever with a temperature and feel unwell. This could be a sign of infection.
  • If the knee joint becomes very swollen or hot or the wound starts to bleed or ooze.
  • If you have severe discomfort in your lower leg – this could be a sign of a deep vein thrombosis.
Rehabilitation after Osteotomy
  • You will be given crutches and a knee brace as necessary and instructions on when and how to use them.
  • You must not drive for 4-6 weeks after surgery.
  • You will need to do gentle activity but nothing strenuous for the first six weeks.
  • After that you can build up back to your previous level of activity and fitness.