• Knee Osteotomy

    (Osteotomy, Knee)

    Definition

    A knee osteotomy is the removal of a wedge of bone from the tibia (the lower leg bone) to realign the leg.
    The Kneecap
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    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 .
    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

    Complications are rare. But no procedure is completely free of risk. If you are planning to have an osteotomy, your doctor will review a list of possible complications, including:
    • Bleeding
    • Reaction to anesthesia
    • Infection
    • Blood clots
    • Nausea and vomiting
    • Injuries to nerves or blood vessels
    • Shortening of the leg
    Factors that may increase the risk of complications include:
    Discuss these risks with your doctor.

    What to Expect

    Prior to Procedure

    Prior to the surgery, the doctor will order tests to confirm the diagnosis and decide how much bone to remove. Tests may include:
    • X-rays
    • MRI scan —uses magnetic waves to make pictures of structures inside the body
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
    In the days leading up to the surgery:
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like anti-inflammatory drugs and blood thinners.
    • Do not eat or drink after midnight the night before surgery.

    Anesthesia

    You may have:

    Description of the Procedure

    There are many methods that can be used to perform an osteotomy. In one method, the doctor uses imaging technology 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. The doctor uses an oscillating saw to remove the bone wedge. The remaining parts of the bone will be held together with staples, screws, or a plate and screws. The doctor will stitch the tissue together and close the area.

    Immediately After Procedure

    You will stay in the recovery room for a couple of hours. The nurses will monitor your vital signs. You may be given pain medicine.

    How Long Will It Take?

    1-3 hours

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Your doctor will give you pain medicine after surgery.

    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
    While you are recovering in the hospital, the staff may:
    • Give you pain medicine
    • Place padded bandages over the incision sites
    • Apply ice to reduce swelling
    • Have you move your leg to improve circulation and reduce the risk of blood clots—You may use a continuous passive motion (CPM) machine if your bone has been stabilized by a plate and screws. It takes your legs through range-of-motion exercises.
    • Have you breathe deeply and cough 10-20 times every hour to decrease the risk of getting a lung infection
    You may have a brace or cast. You will need to use crutches or a walker.
    At Home
    When you return home, do the following for a smooth recovery:
    • Take pain medicine as directed.
    • Apply ice or a cold pack to the area for 15-20 minutes four times a day. Wrap the ice in a towel. Do not apply it directly to your skin.
    • Elevate the injured leg to reduce swelling.
    • If you have a cast, follow the doctor’s instructions for taking care of your skin.
    • Use crutches or a walker. Avoid putting weight on your injured leg until your doctor gives you permission.
    • Keep the incision area clean and dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water. Place a plastic covering over the incision areas if your doctor recommends keeping it dry.
    • In 6-8 weeks, start working with a physical therapist. The therapist will focus on balance, range-of-motion, and strength training.
    • 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 six months.

    Call Your Doctor

    After you leave the hospital, contact your doctor if you have:
    • Signs of infection (eg, fever, chills)
    • Redness, swelling, increasing pain, excessive bleeding, or discharge around the incision site
    • Increased pain or swelling
    • Cough, shortness of breath, chest pain
    • Severe nausea or vomiting
    • Numbness, tingling, or loss of feeling in your leg, knee, or foot
    • Swelling, heat, or pain in your calf
    • Pain, burning, urgency or frequency of urination, or blood in the urine
    In case of an emergency, call for medical help right away.

    RESOURCES

    American College of Rheumatology http://www.rheumatology.org/

    The Arthritis Foundation http://www.arthritis.org/

    CANADIAN RESOURCES

    The Arthritis Society http://www.arthritis.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Brouwer R, van Raaij T, Bierma-Zeinstra S, Verhagen A, Jakma T, Verhaar J. Osteotomy for treating knee osteoarthritis. Cochrane Reviews website. Available at: http://www2.cochrane.org/reviews/en/ab004019.html . Accessed November 23, 2010.

    Carson-DeWitt R. Spinal and epidural anesthesia. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 20, 2010. Accessed November 23, 2010.

    Frequently asked questions: high tibial osteotomy. New England Musculoskeletal Institute website. Available at: http://nemsi.uchc.edu/clinical%5Fservices/orthopaedic/sportsmedicine/faqs/faqs%5Fhto.html . Accessed November 23, 2010.

    Knee osteotomy. The Knee Society website. Available at: http://www.kneesociety.org/web/patienteducation%5Fosteo.html . Accessed November 23, 2010.

    Knee osteotomy. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/knee-osteotomy/MY00710 . Updated November 5, 2010. Accessed November 23, 2010.

    Marti R, Verhagen R, Kerkhoffs G, Moojen T. Proximal tibial varus osteotomy. Journal of Bone and Joint Surgery website. Available at: http://www.jbjs.org/Comments/JBJA0830201640.pdf . Published February 2001. Accessed November 23, 2010.

    Osteoarthritis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 15, 2010. Accessed November 23, 2010.

    Osteotomy. Cedars-Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Programs-and-Services/Orthopaedic-Center/Treatment/Osteotomy.aspx . Accessed November 23, 2010.

    Wilson A. Knee osteotomy and painful osteoarthritis. Knee Guru Information Hub website. Available at: http://www.kneeguru.co.uk/KNEEnotes/node/2153 . Accessed November 23, 2010.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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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