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The Knee Clinic

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Some patients with osteoarthritis in one part of the knee can avoid knee replacement surgery for many years, and sometimes for ever. Typically the osteoarthritis is in the medial compartment and the patient has a bowed leg, known as varus. Often osteotomy is combined with other procedure such as cartilage transplantation , marrow stimulation or ACL reconstruction as part of a biologic knee replacement.  These procedures cannot be done in isolation unless limb is mal-alignment is corrected.

In the patient under 55 years of age who are not overweight, an osteotomy can be a much better alternatives than either partial or total knee replacement. The Australian Hip &  Knee Registry has identified a higher revision rate in males under 55 with partial knee replacement, compared to older patients.

The preoperative x-ray to the top-right shows the medial compartment is narrowed as a result of osteoarthritis.

The limb is too “bowed” or as surgeons call it, in “varus”.

To relieve the pain, the limb mal - alignment is corrected back to neutral or slightly over-corrected, through a small 2 inch incision over the medial tibia. There is some evidence that this allows to articular surfaces to recover and slows the rate of osteoarthritis.

The left image is an x-ray taken while Dr Vertullo is performing an osteotomy, putting the final plate into place. The plate contains a small wedge, that hold the bony correction open while it heals, and the screws hold the plate in place.  If the correction is large, artificial bone graft helps the bone heal faster. The average correction required is 10 degrees. 

Patients are usually in hospital for 2 nights, and touch weight bear for 6 weeks after the surgery on crutches. Depending on progress, they can start riding a bike within a four weeks.  Full recovery is up to 6-9 months.  Most patients a marked improvement in their pain for 10-12 years. It does not effect the later outcome of a knee replacement if performed with modern techniques. 

Risks are mainly in the post-operative phase, and include infection 1:100, Non-union 1:50, Hardware Removal 1:10, Numbness around the wound 1:20 and Slight Loss of knee range of motion 1:10.

Initial Image

Wire Placed

Osteotome

Placed

Distractor

Placed

Temporary Wedge

Placed

Initial Plate Fixation

Final Fixation with Plate

Operative Sequence of an Osteotomy