In a perfectly aligned knee, weight is evenly distributed across the joint. In a malaligned knee, the knee is angled in an inward position like 'knock knee', or an outward position, such as bow leg. Knee malalignment results in an uneven ditribution of weight across the joint which can encourage wear to the joint surfaces. Malalignment can also cause patellar instability.
Our specialists at Schoen Clinic London are experts in treating conditions of the knee. They will explore your options with you to find the right solution, giving you the best possible outcome from knee malalignment treatment.
High tibial osteotomy surgery
In cases of knee malalignment like bow leg, you will most often find medial compartment osteoarthritis. (In cases of knock knee, the malalignment does the opposite and you will likely find lateral compartment osteoarthritis.) An osteotomy procedure involves a controlled surgical break of the bone so that the limb can be realigned, both straightening the joint and limiting the damage to cartilage and meniscus.
The procedure usually begins with an arthroscopy of the knee joint. An arthroscopy involves tiny incisions made to the front of the knee, so your surgeon can identify and treat any mensical tears and cartilage damage. Afterwards, your surgeon will perform the controlled osteotomy (fracture) of the tibia through two small incisions just below the knee on the inside aspect of the leg. The tibia is gently wedged open to realign the leg and X rays are taken perioperatively (during the surgery) to accurately calculate how much to open the wedge to realign the knee. This wedge is then held in place with a strong metal plate and fixed with screws before the skin is closed and dressed with bandages.
The procedure is under general anaesthewtic (you will be asleep throughout the surgery) and it takes 1-2 hours to complete.
Smoking has a negative impact on fracture healing so we ask patients who smoke to quit as soon as possible, preferably 3 months prior to surgery.
We conduct a full health assessment before your operation to establish your general health and mobility. Any exercises you need to do before and after surgery and your pain management plan will be discussed in detail. Effective recovery is essential following surgery so we also explore your home circumstances during your consultation. This is so we can advise on things you may need to put in place before you have your surgery to enable you to return home to a safe and comfortable environment.
Your timings will be confirmed prior to your surgery date, but generally you should not eat anything from midnight the night before, and drink only water up until around 5am. Your ananesthetist will discuss the plan with you in your room and the surgery team will answer any questions and mark your leg before going down to theatre.
After the high tibial osteotomy is complete you will be taken to the recovery room where a cryocuff will be applied to cool the knee. This helps to reduce swelling and pain. We use a combination of medication before, during and after your surgery that minimises bleeding, swelling and pain. Though this pain relief will last for a while after the surgery, we carefully monitor your pain level so we can adjust your medication, should you need it.
Your physiotherapist will see you after surgery to discuss your post-op exercises and help you mobilise using crutches. The crutches are only for support and most patients will be able to weight bear on the operated leg - as much as pain allows.
Due to the nature of the surgery, (osteotomies are considered as major surgeries) you will experience some swelling of your leg. This will go down after roughly 2 weeks. Bruising following high tibial osteotomy can be extensive but it settles quickly in most cases.
Depending on how quickly you recover, you can expect to stay in hospital for 1-2 nights. High tibial osteotomy recovery can be a long process with the knee gradually healing over the course of 6 months, but we're here to help you get the best results from your surgery.
Your individual therapy plan
Our multidisciplinary team of Consultant Orthopaedic Surgeons, leading Sports and Exercise medicine Physicians, Consultant Anaesthetists, Specialist Nurse Practitioners, Physiotherapists and Rehabilitation experts work together at Schoen Clinic London to shape your recovery for optimum results, with an individually formulated plan.
Recovery at home
What to expect from your continued recovery at home:
- Regular pain relief as prescribed
- Rest and elevate your leg above the height of your pelvis when you can
- Ice your knee to reduce swelling over the first 6 weeks
- Physiotherapy as outlined at the appropriate stages
You will be seen for a follow up appointment a few weeks after surgery for new X rays so your consultant can check on your progress.