Osteotomy of Femur & Tibia
High Tibial Osteotomy
What is High Tibial Osteotomy?
High tibial osteotomy is a surgical procedure performed to relieve pressure on the damaged site of an arthritic knee joint. It is usually performed in arthritic conditions affecting only one side of your knee and the aim is to take pressure off the damaged area and shift it to the other side of your knee with healthy cartilage. During the surgery, your surgeon will remove or add a wedge of bone either below or above the knee joint depending on the site of arthritic damage.
Indications for High Tibial Osteotomy
High tibial osteotomy is commonly performed for osteoarthritis that is isolated to a single compartment (unicompartmental osteoarthritis). It is also performed for treating a variety of knee conditions such as gonarthrosis with varus or valgus malalignment, osteochondritis dissecans, osteonecrosis, posterolateral instability, and chondral resurfacing.
High Tibial Osteotomy Procedure
The goal of the surgery is to release the involved joint compartment by correcting the malalignment of the tibia and maintain the joint line perpendicular to the mechanical axis of the leg. There are two techniques that may be used: closing wedge osteotomy and opening wedge osteotomy. Your surgeon determines the choice of the technique based on your requirement.
Closing Wedge Osteotomy
Closing wedge osteotomy is the most commonly used technique. In this procedure, your surgeon makes an incision in front of the knee and removes a small wedge of bone from the upper region of the tibia (shinbone). This manipulation brings the bones together and fills the space left by the removed bone. Your surgeon then uses plates and screws to bind the bones together while the osteotomy heals. This procedure unloads the pressure off the damaged joint area and helps to transfer some of the weight to the outer part of the knee, where the cartilage is still intact.
Opening Wedge Osteotomy
In this procedure, your surgeon makes an incision in front of the knee, just below the kneecap and makes a wedge-shaped cut in the bone. Bone graft is used to fill the space of the wedge-shaped opening, and if required, plates and screws can be attached to further support the surgical site during the healing process. This realignment increases the angle of the knee to relieve the painful symptoms.
Complications of High Tibial Osteotomy
Complications following high tibial osteotomy may include infection, skin necrosis, non-union (failure of the bones to heal), nerve injury, blood vessel injury, failure to correct the varus deformity, compartment syndrome, and deep vein thrombosis or blood clots.
Distal Femoral Osteotomy
What is Distal Femoral Osteotomy?
An osteotomy is a surgical procedure that involves cutting of bone. The distal femur is part of the femur (thighbone) just above the knee joint. Distal femoral osteotomy is performed to correct knee alignment which can lead to excessive loading and degeneration of one side of the knee joint. The procedure involves cutting of the distal femur, repositioning the bones and securing them in the proper alignment.
Indications for Distal Femur Osteotomy
Malalignment of the bones at the knee joint may be present at birth or may occur due to trauma or arthritis. Two types of deformity usually occur:
- Genu varum: The tibia (shinbone) turns inwards in relation to the femur causing a bow-legged deformity.
- Genu valgus: The tibia turns outwards in relation to the femur causing a knock-knee deformity
A distal femoral osteotomy is recommended if you have a genu valgus deformity causing degeneration in the outer (lateral) part of the knee.
During a distal femoral osteotomy, the femur is lined up surgically so that the femoral axis passes through the center of the knee and pressure on the damaged side of the knee joint is relieved.
Who is Eligible for Distal Femoral Osteotomy?
You may be a candidate for distal femoral osteotomy if you are:
- Less than 60 to 65 years old
- Physically active and healthy
- Affected by lateral arthritis only
Techniques of Distal Femoral Osteotomy
There are two main techniques to perform a distal femoral osteotomy:
- Lateral opening wedge osteotomy
- Medial closing wedge osteotomy
Lateral opening wedge osteotomy is considered easier and more accurate.
Procedure for Distal Femoral Osteotomy
Distal femoral osteotomy is usually performed under general anesthesia. The following technique is used:
- An incision is made over the distal femur where the osteotomy is to be performed. A medial closing wedge osteotomy is performed on the inside of the femur while a lateral opening wedge osteotomy is performed on the outside.
- The cut in the distal femur is made using an oscillating saw and a predetermined section of bone is removed.
- For a medial closing wedge osteotomy, a wedge-shaped section of bone is removed and the opening is closed by bringing the cut ends of the bones together, thus changing the alignment of the bones.
- For a lateral opening wedge osteotomy, a wedge-shaped section of bone is removed and the gap is opened further to change the alignment of the bones. A bone graft is inserted into the gap so that the bones fuse in the new alignment.
- The bones are secured in position with the help of metal plates and screws.
- The incision is closed and healing occurs the same way a fracture heals.
Recovery from Osteotomy Surgery
After the operation, healing may take between 2 to 6 months before you can resume normal activities.
Benefits of Distal Femoral Osteotomy
Distal femoral osteotomy can:
- Reduce knee pain significantly
- Improve knee function
- Delay the need for knee replacement