What’s an Osteotomy
Elsewhere in the world, osteotomy techniques have evolved and this operation is regarded as a real alternative to knee replacement in some patients. It is not suitable for everyone with knee problems; some patients require knee replacement surgery.
Osteotomy 35 years ago
As you might expect, knee realignment surgery back then was far less sophisticated than it is today. Imaging techniques were not as advanced, the materials used to fix the bone together were not as strong and aftercare involved having the knee set in a cast for six weeks. The results were not good. People found that their knee stiffened up after being in the cast for so long and the realignment was rarely accurate since it was usually done ‘by eye’.
Osteotomy today
Over the last 20 years, imaging of the skeleton has become highly accurate and osteotomy surgery can be planned accurately to within a fraction of a millimetre.
Computer assisted surgery that has been planned using accurate CT scans allows the surgeon to operate according to the individual need of each patient.
Newly developed surgical instruments ensure that the accurate measurements obtained in the planning stage are translated into accurate bone fixation using much improved metal plates and pins. These hold the bone in place so rigidly and immediately that you can bear your own weight on the knee joint within 24 hours of your osteotomy realignment.
Osteotomy 35 years ago
As you might expect, knee realignment surgery back then was far less sophisticated than it is today. Imaging techniques were not as advanced, the materials used to fix the bone together were not as strong and aftercare involved having the knee set in a cast for six weeks. The results were not good. People found that their knee stiffened up after being in the cast for so long and the realignment was rarely accurate since it was usually done ‘by eye’.
Osteotomy today
Over the last 20 years, imaging of the skeleton has become highly accurate and osteotomy surgery can be planned accurately to within a fraction of a millimetre.
Computer assisted surgery that has been planned using accurate CT scans allows the surgeon to operate according to the individual need of each patient.
Newly developed surgical instruments ensure that the accurate measurements obtained in the planning stage are translated into accurate bone fixation using much improved metal plates and pins. These hold the bone in place so rigidly and immediately that you can bear your own weight on the knee joint within 24 hours of your osteotomy realignment.
Being slightly bow-legged:
this results in damage to the knee joint on the inner side (called the medial portion of the knee joint)
Being slightly knock-kneed:
this results in damage to the knee joint on the outer side (called the lateral portion of the knee joint)
Osteotomy for bow-legged patients
This procedure is called a high tibial osteotomy and involves realignment of the top part of the tibia (the shin bone). Around 80% of the osteotomy operations carried out by our experts of this type.
A wedge is cut into the bone, guided by accurate scan results and pre-surgery calculations.
The bone is pulled apart slightly and then fixed into its new position using a metal plate and pins.
You can see these in the X-ray on the left.
The X-ray below left shows the alignment of the patient’s left leg before their osteotomy. The X-ray on the right shows how surgery has realigned the leg so the knee joint is better balanced.
Osteotomy for knock-kneed patients
This operation is called a femoral osteotomy and involves realignment of the bottom part of the femur (the thigh bone).
Femoral osteotomies account for 15% of all knee realignment operations performed by our experts.
Cuts are made in the bone guided by the pre-surgery imaging and planning and plates and pins are used to fix the bone into its new position.
Again, the whole leg is realigned in the surgery so that further damage to one side of the knee does not continue.
The X-ray on the left (below) shows how the knee joint is not aligned properly before surgery but is aligned correctly after surgery.
