Knee Realignment Osteotomy
Surgical Realignment of the Knee to Correct Deformities and Relieve Joint Pressure for Improved Mobility.
Knee Realignment Osteotomy is a surgical procedure designed to relieve pain and improve function in patients suffering from knee conditions such as early-stage osteoarthritis or structural misalignment. This procedure helps redistribute the weight-bearing forces in the knee joint by realigning the bones of the leg. It is often recommended for individuals who are too young or active for knee replacement surgery, as it can help delay or prevent the need for joint replacement.
Dr Liddell performs knee realignment osteotomy with the goal of relieving pain, restoring joint function, and preserving the natural knee for as long as possible. If you are experiencing knee pain due to alignment issues, this surgery may offer significant relief and enable you to return to the activities you enjoy.
- WHEN KNEE REALIGNMENT OSTEOTOMY MIGHT BE RECOMMENDED
- TYPES OF KNEE REALIGNMENT OSTEOTOMY SURGERIES
- THE KNEE REALIGNMENT OSTEOTOMY SURGICAL PROCEDURE
- POST-OPERATIVE EXPECTATIONS AFTER KNEE REALIGNMENT OSTEOTOMY
- RECOVERY TIMELINES FOLLOWING KNEE REALIGNMENT OSTEOTOMY
- RISKS ASSOCIATED WITH KNEE REALIGNMENT OSTEOTOMY
WHEN KNEE REALIGNMENT OSTEOTOMY MIGHT BE RECOMMENDED
Knee realignment osteotomy might be recommended for patients with early-stage osteoarthritis or knee pain caused by alignment problems, such as bow-leggedness (varus alignment) or knock-knees (valgus alignment). These alignment issues can lead to uneven weight distribution in the knee joint, resulting in increased pressure on one side of the knee and causing pain or damage to the cartilage.
This procedure may be a suitable option if:
- You experience pain primarily on one side of the knee.
- You have early-stage osteoarthritis or damage that is limited to one compartment of the knee joint.
- You are too young or active for a knee replacement.
- Conservative treatments such as physiotherapy, medication, or bracing have not provided sufficient relief.
- Knee realignment osteotomy can be an effective way to slow the progression of arthritis and postpone the need for a knee replacement.
TYPES OF KNEE REALIGNMENT OSTEOTOMY SURGERIES
There are two primary types of knee osteotomy procedures, and the choice depends on the patient’s specific alignment issue and the location of the knee pain:
- High Tibial Osteotomy (HTO): This procedure is typically performed for patients with varus alignment (bow-leggedness), where the inside (medial) part of the knee bears too much weight. In an HTO, the tibia (shinbone) is cut and realigned to shift the weight towards the healthier, outer side of the knee. This reduces pressure on the damaged or arthritic area.
- Distal Femoral Osteotomy (DFO): For patients with valgus alignment (knock-knees), a DFO may be recommended. In this case, the femur (thighbone) is cut and realigned to shift the weight towards the inner side of the knee, relieving pressure on the outer compartment of the joint.
Dr Liddell will assess your knee alignment, level of damage, and overall health to determine which type of osteotomy is most appropriate for your condition.
THE KNEE REALIGNMENT OSTEOTOMY SURGICAL PROCEDURE
Knee realignment osteotomy is performed under general or regional anaesthesia and typically involves the following steps:
- Incision and Exposure: An incision is made along the side of the knee, either over the tibia or femur, depending on the type of osteotomy being performed. This provides access to the bone that will be realigned.
- Bone Cutting (Osteotomy): Dr Liddell carefully cuts through either the tibia(High Tibial Osteotomy (HTO)) or femur (Distal Femoral Osteotomy (DFO) using specialised surgical instruments. The bone is then adjusted and realigned to create a more balanced distribution of weight in the knee joint. In some cases, a wedge of bone may be removed or added to achieve the correct alignment.
- Securing the Bone: After the bone is realigned, it is secured in its new position using plates and screws. These fixation devices help hold the bone in place while it heals. In some cases, a bone graft may be used to fill any gaps created during the realignment process.
- Closing the Incision: Once the realignment is complete and the bone is securely fixed, the incision is closed with sutures or staples, and a bandage is applied to the knee.
POST-OPERATIVE EXPECTATIONS AFTER KNEE REALIGNMENT OSTEOTOMY
Immediately after the knee realignment osteotomy procedure, you will be taken to the recovery room to be monitored as the anaesthesia wears off. Pain management and post-operative care are crucial in the first few days after surgery. Dr Liddell will provide you with pain relief medications and instructions on how to care for your knee during the initial healing phase.
Most patients will need to use crutches for several weeks to keep weight off the knee while the bone heals. You may also need to wear a brace to protect the knee and support the new alignment. Dr Liddell will provide you with detailed post-operative instructions to ensure a smooth and safe recovery. Adhering to these guidelines is essential for optimal healing and preventing complications.
These instructions typically cover the following areas:
WOUND CARE
Proper care of your surgical wound is crucial for preventing infection and promoting healing:
You should avoid getting the incision site wet for the first 7-10 days after surgery. Your dressings should remain clean and dry. Dr Liddell will provide instructions on when it is safe to shower and how to protect the wound from moisture.
You may be given instructions to change the dressings periodically or visit a healthcare provider for follow-up wound care. Be sure to follow these instructions closely.
It’s important to watch for any signs of infection, such as redness, swelling, increased warmth around the incision, or discharge. If you notice any of these symptoms, contact Dr Liddell immediately for further evaluation.
If non-dissolvable stitches or staples are used to close the incision, you will need to return for their removal, usually 10-14 days post-surgery. Dr Liddell’s team will provide information about your follow-up appointment for this.
Pain Management
Pain and discomfort are normal in the initial days following knee realignment osteotomy. Managing pain effectively can improve your comfort and aid in the recovery process. Dr Liddell will provide a pain management plan that may include:
- Prescription Pain Medications: You may be prescribed stronger pain relief medications for the first few days after surgery. It’s important to take these as directed to manage acute pain and to gradually transition to over-the-counter pain relievers as you recover.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen, may be recommended to help reduce pain and inflammation. Follow the dosage instructions carefully to avoid potential side effects.
- Icing the Knee: Applying ice packs to the knee in intervals can help reduce swelling and discomfort. Dr Liddell will provide specific instructions on how long and how often to apply ice. Typically, 15-20 minutes of icing every few hours can be effective.
- Elevating the Leg: Keeping your leg elevated above the level of your heart can also help reduce swelling and improve circulation. Dr Liddell may recommend that you elevate your leg as much as possible during the first week post-surgery.
Activity Restrictions
Rest and limiting movement are critical to allow the bone to heal properly after surgery. Dr Liddell will give you clear guidelines on activity restrictions during your recovery:
- Weight-Bearing Limitations: You will likely need to avoid placing full weight on the affected leg for several weeks. In most cases, crutches or a walker will be required to aid mobility while keeping pressure off the knee. Dr Liddell will advise when partial or full weight-bearing can be gradually introduced, which often depends on X-rays showing proper bone healing.
- Use of a Brace or Immobiliser: A knee brace may be used to protect the surgical site and prevent unintended movements that could disrupt the healing process. Dr Liddell will instruct you on how long to wear the brace and whether it should be worn continuously or only during certain activities.
- Limited Physical Activity: It is essential to avoid activities that put stress on the knee, such as walking long distances, climbing stairs, or bending the knee extensively. Specific exercises or physiotherapy will be introduced gradually once Dr Liddell determines it is safe to do so.
- Gradual Introduction of Physiotherapy: Physiotherapy will play a significant role in your recovery, but it will not start immediately after surgery. Dr Liddell will provide a timeline for when gentle exercises to restore range of motion can begin, typically after the initial bone healing phase. Physiotherapy will become more focused on strengthening the knee and improving mobility as your recovery progresses.
By following these instructions, you can help ensure a successful recovery after knee realignment osteotomy. Dr Liddell and his team will monitor your progress during follow-up appointments and make adjustments to your recovery plan as needed.
RECOVERY TIMELINES FOLLOWING KNEE REALIGNMENT OSTEOTOMY
Recovery from knee realignment osteotomy is a gradual process, and it typically takes several months for the bone to heal fully.
The following timeline provides a general overview of the recovery process:
- First 6 Weeks: During the initial phase of recovery, you will need to use crutches and avoid putting weight on the knee. Physiotherapy will begin with gentle range-of-motion exercises to prevent stiffness and improve flexibility.
- 6 to 12 Weeks: As the bone continues to heal, you will gradually transition to weight-bearing activities. Physiotherapy will focus on strengthening the muscles around the knee and improving your balance and stability.
- 3 to 6 Months: Most patients can return to low-impact activities such as walking or swimming after three to six months, depending on the healing progress.
- 6 to 12 Months: By this stage, most patients can resume more strenuous activities, including sports, but the exact timeline will depend on how well the knee has healed and how you respond to rehabilitation.
RISKS ASSOCIATED WITH KNEE REALIGNMENT OSTEOTOMY
While knee realignment osteotomy is generally considered safe, there are potential risks and complications that you should be aware of.
These include:
- Infection: As with any surgery, there is a risk of infection at the incision site or deeper within the knee joint.
- Blood Clots: Deep vein thrombosis (DVT) can occur after surgery, and preventative measures will be taken to reduce this risk.
- Nerve or Blood Vessel Damage: Although rare, there is a risk of injury to the nerves or blood vessels around the knee during surgery.
- Non-Union or Delayed Healing: In some cases, the bone may take longer to heal than expected, or the bone may fail to heal properly, requiring further intervention.
- Persistent Pain or Stiffness: Some patients may experience ongoing pain or stiffness in the knee after surgery, which may require additional treatment or rehabilitation.
Dr Liddell will discuss these risks in detail with you before the surgery and provide you with comprehensive post-operative care to help minimise any potential complications. Knee realignment osteotomy can be an effective option for patients looking to alleviate pain, restore function, and preserve their knee joint. If you have any questions or would like more information about the procedure, Dr Liddell is available to provide personalised advice based on your condition and needs.