Leg realignment osteotomy: a patient’s guide to knee alignment surgery

Leg realignment osteotomy is a well-established orthopaedic surgery used to correct abnormal alignment of the lower limb, most commonly around the knee. It is frequently considered for patients with pain caused by uneven joint loading, particularly in the earlier stages of knee arthritis.

What is a leg realignment osteotomy?

A leg realignment osteotomy involves carefully cutting and reshaping the bone, usually the tibia or femur, to improve mechanical alignment of the leg.

When the knee is misaligned, one side of the joint bears more load than the other. Over time, this can accelerate cartilage wear and contribute to osteoarthritis. By correcting alignment, weight is redistributed more evenly across the joint, helping to reduce pain and slow disease progression.

Who is a suitable candidate?

This procedure is commonly considered for:

• Patients under 60 years of age.
• Individuals with early to moderate knee arthritis.
• Patients with bow-legged (varus) or knock-kneed (valgus) alignment.
• Active individuals wishing to delay or avoid knee replacement surgery.

When it may not be suitable

It may be less appropriate in cases of advanced, “bone-on-bone” arthritis affecting the entire knee joint, as the procedure relies on preserving remaining healthy cartilage. It may also not be suitable in individuals with poor bone quality, such as significant osteoporosis. In addition, patients with major medical conditions that increase surgical risk or significantly limit rehabilitation may not be ideal candidates.

A specialist assessment, including weight-bearing X-rays, is essential before recommending surgery.

Types of osteotomy procedures

There are two main surgical techniques used to correct lower limb alignment, with the choice depending on the location and degree of malalignment.

High tibial osteotomy (HTO)

High tibial osteotomy is the most commonly performed procedure. It is typically used to correct bow-legged alignment by adjusting the upper tibia to offload the damaged part of the knee.

Distal femoral osteotomy (DFO)

Distal femoral osteotomy is used less frequently and is indicated in patients with knock-knee deformity, where correction is required at the femur.

What does the surgery involve?

The operation is performed under general or spinal anaesthesia. A controlled bone cut is made, and the limb is carefully realigned to the planned correction angle.

The bone is stabilised using a metal plate and screws to maintain the new position while healing occurs. In some cases, a wedge of bone is added or removed depending on the correction required. The procedure typically lasts between one and two hours.

Recovery and rehabilitation

Early recovery involves a short hospital stay with pain management and early guided movement. Crutches are usually needed for several weeks, with weight-bearing increased gradually as healing progresses.

Rehabilitation is essential, with physiotherapy helping to restore strength and mobility. Recovery is gradual and may take several months, as full bone healing is required before returning to unrestricted activity.

Benefits of leg realignment osteotomy

1. Reduction in knee pain.
2. Improved limb alignment and function.
3. Delay in progression of knee arthritis.
4. Potential to postpone knee replacement surgery.

Risks of leg realignment osteotomy

Risks include infection, blood clots, delayed bone healing, or incomplete correction. These risks are relatively low in appropriately selected patients.

Leg realignment osteotomy is an effective joint-preserving procedure for carefully selected patients with knee malalignment and early arthritis. By improving biomechanics, it can reduce pain and preserve knee function for longer.

Visit Mr Ahmad Ali’s Top Doctors profile to explore whether a leg realignment osteotomy is suitable for your knee condition and overall joint health.