High Tibial Osteotomy

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A high tibial osteotomy is a surgical procedure that realigns the knee joint. For some patients who have knee arthritis, this surgery can delay or prevent the need for a partial or total knee replacement by … Read More

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High Tibial Osteotomy

A high tibial osteotomy is a surgical procedure that realigns the knee joint. For some patients who have knee arthritis, this surgery can delay or prevent the need for a partial or total knee replacement by preserving damaged joint tissue. DIAGNOSIS: The predominant indication is lower limb osseous malalignment in younger patients who have medial tibiofemoral joint pain. The high tibial osteotomy technique is a surgical procedure performed to realign the leg and reduce the pain in the knee by transferring the body weight to the preserved outer side of the knee. A high tibial osteotomy procedure does not, however, return the knee to normal. Instead, it extends the lifespan of a damaged knee, helps to relieve pain in the knee, and delays the need for a complete knee replacement. However, a high tibial osteotomy technique helps to evenly distribute the weight from the hip, through the knee to the center of the ankle, to bring about an even contact with the ground.  Why is a high tibial osteotomy surgery requested? There are two major conditions that may require this technique
  • Knee arthritis; which occurs when there is loss of cartilage in the knee. 
  • Osteoarthritis; which occurs when bone rides against bone, thereby causing the knee joint to be stiff and painful.
Preparation for a high tibial osteotomy surgery Prior to carrying out a high tibial osteotomy procedure, X-rays and MRIs of the knee will have to done to assess and gauge the degree of arthritis and structure damage. This helps to get a clear view of how the compartment is functioning, predict where the majority of the weight is being carried, and how to correctly realign the leg to achieve the best outcome. Procedure of a high tibial osteotomy surgery There are two methods of a high tibial osteotomy procedure
  • Closing wedge osteotomy: For this high tibial osteotomy procedure, a piece of bone is removed from below the joint of the upper tibia. If arthritis has affected the medial knee compartment, a triangular bone wedge is taken from the outer region of the tibia (the bone beneath the knee). Once the bone segment has been removed, the two bone ends are fixed together with a metal plate and pins.
  • Opening wedge osteotomy: For this high tibial osteotomy procedure, the tibia is sliced through on the inner side to open a wedge. This procedure involves adding a segment of the bone graft from the pelvic bone to hold the region open. A plate and pins are then inserted to bring stability. This procedure is usually carried out at the upper side of the tibia, right just below the knee joint.
High tibial osteotomy recovery A day after the surgery, you will be taught how to use crutches; this lasts for up to three months. Most patients will be able to go home three days after the procedure. However, therapy must continue from home, to help improve mobility and regain the muscular strength of the knee joint. In the first week after the procedure, the leg will be swollen and the knee will be stiff. This can be easily taken care of with pain medication. Full recovery from a high tibial osteotomy technique may take up to six (6) months. The most important aspect of rehabilitation, however, is to strengthen the knee and allow it to heal.

Symptoms

• Angular deformity

• Prognosis

Causes

• Heredity – Some people have an inherited defect in one of the genes responsible for making cartilage.

• Obesity – Obesity increases the risk for osteoarthritis of the knee, hip, and spine.

• Injury – Injuries contribute to the development of osteoarthritis.

• Joint overuse.

• Other diseases.

FAQ

Are there any high tibial osteotomy complications?

Just like other forms of surgeries, there are a number of risks that associated with high tibial osteotomy. The following are possible high tibial osteotomy complications that may occur;

  • Bleeding.
  • Infection.
  • Blood clots in the vein of the legs.
  • Knee stiffness.
  • Damage to the surrounding blood vessels and/or nerves.
  • Failure of the cut bone to heal.
  • Discomfort from the metal-ware and subsequent removal.
  • Unexpected fractures.
  • Pain.
  • Swelling and numbness of the leg.
  • Anaesthetic complications.

What are the alternatives to a high tibial osteotomy surgery?

There are a number of non-surgical options available as an alternate;

  • Use of pain medication. 
  • Use of walking stick.
  • Use of a brace around the knee. 

What is high tibial osteotomy success rare?

Most patients who undergo a high tibial osteotomy surgery enjoy fully functioning knees for 5 to 10 years following the surgery.

About 70% reports satisfaction, while 75% are able to return to sports and/or work activities.

What are the benefits of high tibial osteotomy?

Some of the benefits derived from a high tibial osteotomy are;

  • Some ligament around the knee function.
  • Minimizes arthritis in other compartments of the knee.
  • Adequate range of motion.