High Tibial Osteotomy

Sometimes arthritis of the knee in a young or middle-aged patient is best treated by an operation that alters the way forces cross the knee, taking pressure off the damaged joint surface.

Osteotomy means to surgically break the tibia under control. After the tibia is broken it can be realigned into a better position and allowed to heal. Once healed, the force of the body is transmitted mainly through undamaged cartilage, and patients will have less pain and swelling. For the operation to be effective the arthritis needs to be confined to one area of the knee only. The rest of the joint must be healthy.

Before suggesting an Osteotomy, Joint Reaction prefer to try and control your symptoms with physiotherapy, anti-inflammatory medication and, possibly, key-hole surgery. If these techniques are not successful then an Osteotomy would be considered.

Osteotomy is usually not suitable for patients much over the age of 60. Unicompartmental knee replacement is generally a better option for the older patient.

What happens at surgery?

Under general anaesthetic, a 10 cm incision is made over the upper part of the tibia (shin bone). The bone is cut almost all the way across, and the alignment of the tibia is carefully adjusted until the desired angle is reached. The bone is then fixed with a plate that is held in place with screws.

We try not to completely break the tibia as to ensure that the final result is strong and stable. Sometimes this is not possible although the operation will still provide excellent results. In the cases where the bone has had to be completely broken we suggest that you be a little more careful after the operation until it has healed.

High Tibial Osteotomy 1

High Tibial Osteotomy 2

High Tibial Osteotomy 3

After the operation

Most patients are ready to go home after 48 hours. You will need to wear a knee brace for at least six weeks. This allows up to 90 degrees of bend but prevents inadvertent sideways bending. You will need to very lightly bear weight on the operated leg for the first few weeks and so crutches will be necessary. After six weeks, if the x-rays show the tibia is healing well, the amount of weight-bearing can be increased, still using the knee brace for up to three months. If the fixation is not as stable as we would like, we may need you to wear a plaster cast on the leg for the first few weeks, just to be absolutely safe.

Long term outlook

This operation is designed to improve the symptoms of knee arthritis but it cannot cure the disease. It will eventually get worse and further surgery will almost certainly be necessary.

Studies have shown that osteotomy can delay the need for a knee replacement for up to 10 years and this is often enough to keep the knee comfortable until, for example, the patient retires from work. The advantage over a knee replacement in the younger patient is that it does not involve placing an implant into the knee itself, and once it has healed, you can lead a busy, vigorous life, even returning to sport in some cases.

For the patient in their late fifties or early sixties, however, a unicompartmental knee replacement may be a better alternative.

Clare Park Hospital | Crondall Lane | Crondall | Farnham | Surrey | GU10 5XX

© Joint Reaction 2008