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Knee Osteotomy

(Osteotomy, Knee)
  • Definition

    A knee osteotomy is the removal of a wedge of bone from the tibia to reshape and realign the leg. The tibia is the shinbone. Recovery time will depend on certain factors, such as your overall health.
    The Kneecap
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    Copyright © Nucleus Medical Media, Inc.
  • Reasons for Procedure

    This procedure aligns the knee joint so the healthy part of the knee surface is able to do more weight-bearing. This takes pressure off the damaged part. Damage is often due to osteoarthritis . This surgery may be done instead of a total knee replacement . It may also be done to correct poor knee alignment for other reasons.
    While osteotomy does not cure conditions like osteoarthritis, the surgery may:
    • Reduce pain
    • Improve movement
    • Delay further damage to the joint
    • Postpone the need for total knee replacement surgery
  • Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Infection
    • Poor healing of the bone
    • Excess bleeding
    • Swelling
    • Blood clots
    • Shortening of the leg
    • Injuries to nerves or blood vessels
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
    • Smoking
    • Drinking
    • Chronic disease such as diabetes or obesity
    • Poor nutrition
    • The use of certain medications
    Your risk of complications may be increased if you have a history of blood clots.
  • What to Expect

    Prior to Procedure
    Prior to the surgery, tests will be ordered to confirm the diagnosis and decide how much bone to remove.
    Tests may include:
    Before surgery, you will need to:
    • Arrange for a ride home.
    • Arrange for help at home while you recover.
    • Talk to your doctor about any allergies you have.
    • Ask your doctor about assisted devices you will need.
    • If you are overweight, lose weight. This will help to decrease the amount of stress on your new joint.
    • Install safety equipment in the bathroom, shower, and on the stairs.
    • Prepare a bedroom on the first floor if possible. Climbing stairs will be difficult at first.
    Talk to your doctor about any medications, herbs, or supplements you are taking. You may be asked to stop taking some medications up to 1 week before the procedure.
    Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
    Anesthesia
    Anesthesia will keep you pain-free and comfortable during the procedure. Anesthesia methods include:
    Description of the Procedure
    There are many methods that can be used to perform an osteotomy. In one method, imaging technology is used to measure the piece of bone that will be removed. A cut is made in the skin from the knee cap to the top of the shinbone. Several thin wires are placed in the knee to serve as guides, showing where the bone should be cut. An oscillating saw is used to remove the bone wedge. The remaining parts of the bone will be held together with staples, screws, or a plate and screws. The tissue will be stitched together and the area will be closed.
    How Long Will It Take?
    1-3 hours
    How Much Will It Hurt?
    Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.
    Average Hospital Stay
    You may need to stay in the hospital for 2-3 days. If you have any problems, you may need to stay longer.
    Post-procedure Care
    At the Hospital
    Right after the procedure, you will be taken to recovery and monitored closely. The staff may:
    • Medication to:
      • Reduce pain
      • Prevent infection
      • Prevent blood clots
    • Place padded bandages over the incision sites
    • Apply ice to reduce swelling
    • Give you a splint or brace to hold the knee in the right position
    During your stay, the hospital staff will take steps to reduce your chance of infection such as:
    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered
    There are also steps you can take to reduce your chances of infection such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incisions
    At Home
    To help ensure a smooth recovery at home, take these steps:
    • Start working with a physical therapist once you are instructed to. The therapist will focus on balance, range-of-motion, and strength training.
    • Maintain a healthy weight after surgery.
    • Follow your doctor's instructions.
    You will need to return to the doctor to have your cast removed or to have x-rays taken. Full recovery can take 6 months.
  • Call Your Doctor

    Call your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Swelling, redness, or pain in your legs, calves, or feet
    • Pain that you cannot control with the medications you have been given
    • Nausea and vomiting
    • Cough, shortness of breath, or chest pain
    • Your leg, foot, or toes appear chalky white, blue, or black
    • Numbness or tingling in your leg, foot, or toes
    If you think you have an emergency, call for emergency medical services right away.
  • RESOURCES

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    OrthoInfo—American Academy of Orthopaedic Surgeons http://orthoinfo.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Degenerative joint disease of the knee. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 18, 2015. Accessed March 4, 2015.

    Knee osteotomy. The Knee Society website. Available at: http://www.kneesociety.org/web/patienteducation%5Fosteo.html. Accessed March 4, 2015.

    Knee replacement surgery. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/orthopaedic/knee%5Freplacement%5Fsurgery%5Fprocedure%5F92,P07673/. Accessed March 4, 2015.

    Marti R, Verhagen R, Kerkhoffs G, Moojen T. Proximal tibial varus osteotomy. J Bone Joint Surg Am. 2001;83-A(2):164-170

    Wilson A. Knee osteotomy and painful osteoarthritis. Knee Guru Information Hub website. Available at: http://www.kneeguru.co.uk/KNEEnotes/node/2153. Published May 13, 2010. Accessed March 4, 2015.

    6/6/2011 DynaMed's Systematic Literature Surveillance http:/www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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