Knee osteotomy: A comprehensive guide

A knee osteotomy is a joint-preserving surgical procedure designed to address knee problems caused by early-stage arthritis.

Mr Tamer Sweed, distinguished consultant orthopaedic surgeon, explains the indications, techniques and outcomes associated with a knee osteotomy.

When is a knee osteotomy recommended?

A knee osteotomy is typically recommended for patients with early-stage arthritis, particularly when the damage is limited to one part of the knee. This condition, known as unicompartmental arthritis, often causes the knee to become misaligned, causing pain and affecting mobility.

Unlike total knee replacement, a knee osteotomy preserves the natural joint and its range of motion. This makes it an ideal choice for younger, more physically active patients who wish to maintain their activity level. Before surgery, patients undergo comprehensive assessments, including imaging studies such as X-rays and MRIs, to determine the extent and location of the damage.

How is a knee osteotomy performed?

A knee osteotomy involves reshaping or repositioning the bones in the knee to improve alignment and redistribute the body’s weight to the healthier parts of the knee joint. This results in reduced pain and delays the need for a knee replacement.

There are two primary types of knee osteotomy:

High tibial osteotomy (HTO)

HTO targets the tibia (shinbone) and is used to correct alignment when the inner part of the knee is more affected. During the procedure, the orthopaedic surgeon makes an incision near the knee and cuts into the tibia to create a wedge of bone. This wedge is either opened (open-wedge osteotomy) or closed (closed-wedge osteotomy) to adjust the alignment. The resulting gap or compression is then secured in its new position with plates and screws.

Distal femoral osteotomy (DFO)

DFO targets the femur (thighbone) and is used when the outer part of the knee is more affected. During the procedure, the orthopaedic surgeon makes an incision near the knee and cuts into the femur to create a wedge of bone. This wedge is either opened (open-wedge osteotomy) or closed (closed-wedge osteotomy) to adjust the alignment. The resulting gap or compression is then secured in its new position with plates and screws.

A knee osteotomy generally takes 1-2 hours, depending on the complexity of the case. Advanced imaging techniques, such as 3D planning, are used to ensure precision during surgery.

Are there any risks associated with a knee osteotomy?

Like with any surgical procedure, a knee osteotomy carries certain risks. These include infection, blood clots, nerve or blood vessel injury, and complications related to the anaesthesia. However, advancements in surgical techniques have significantly minimised these risks.

After surgery, most patients remain in the hospital for 1-3 days. Full weight-bearing is usually restricted for 4-8 weeks, during which crutches or a walker are used for support. Rehabilitation begins soon after the procedure to rebuild strength, flexibility and range of motion, and continues for several months to optimise recovery. Light activities can resume within 3 months, while more intense activities such as sports may require 6-12 months.

How successful is a knee osteotomy?

A knee osteotomy can be highly effective in relieving pain and restoring function to the knee. By redistributing weight within the knee, the procedure reduces stress on the damaged joint and improves alignment. The results of a knee osteotomy can also last 10-15 years, depending on factors such as age, activity level and the severity of the underlying condition.

For many patients, this procedure offers significant pain relief and allows them to return to an active lifestyle, delaying the need for a knee replacement.

To book an appointment with Mr Sweed, head on over to his Top Doctors profile today.