Proximal Tibial Osteotomy
Introduction
Some patients with osteoarthritis have a slight deformity that typically causes their lower leg (tibia) to bend inward. Instead of bearing weight evenly throughout the knee, the slightly bent leg bears too much weight on the inside of the knee. This can cause cartilage to break down.
To correct this problem, you can have an osteotomy (surgical cutting of bone). In this case, the surgeon removes a piece of the upper tibia and then gently straightens the tibia. Shifting the leg bone into better alignment means the inside of the knee bears less weight. This prevents further wearing away of cartilage.
Active people under age 65 are usually good candidates for osteotomy. To find out what you need to do before surgery, see Preparing for Joint Replacement Surgery.
How the Procedure is Done
To straighten the leg, the doctor first cuts the tibia just below the knee joint. He then removes a wedge of bone from the outside part of the tibia, allowing the leg to be shifted slightly. Screws or staples are used to keep the realigned bone in place or the doctor may apply an external fixation frame.
What to Expect Afterwards
You will probably be in the hospital for 3 to 6 days. For what you are likely to experience after surgery, see Getting Around After Knee Surgery.
You may have to use crutches for 6 to 8 weeks. When using crutches, put your weight on your arms and hands rather than your armpits and bend your elbows. Keep your injured leg off the floor by bending your knee. Move both crutches forward. Then swing your uninjured foot between the crutches, landing heel first.
Unlike people who have a total knee replacement, you still have your own knee and you will have no restrictions on your activity once you recover from surgery. You will still have knee pain, although it will not be as bad as before.
The benefits of an osteotomy are usually temporary. Because you will continue to develop arthritic changes in your knee, you will probably need a total knee replacement in about 5 to 7 years.
Risks and Complications
Although complications are rare, there is a small chance of infection or blood clots. There is also a very low risk of the bone not healing properly, a nerve or artery being cut during surgery, or poor skin healing.
