High Tibial Osteotomy
High tibial osteotomy is a method for treating a knee with arthritis that has caused the bones to be positioned incorrectly at the joint. The procedure involves surgically cutting through a bone (osteotomy) in your lower leg (tibia), and removing a wedge of bone to correct the problem with bone position. The tibia is the larger of the two bones in the lower leg between your knee and ankle.
Anatomy and Indications for Surgery
Your knee is made of your thigh bone (femur), a lower leg bone (tibia), the patella (knee cap) and some cartilage and supportive ligaments. Normally, cartilage covers the ends of the bones to help them slide smoothly on each other. Cartilage is dense tissue that can be worn down from overuse or disease. When this happens, moving your knee can be very painful. The reason for the surgery is to reduce the pain from arthritis.
High tibial osteotomy corrects the alignment of the knee and takes pressure off the part of the knee with arthritis. With the change in your knee's structure, the pressure is transferred to an area of healthy cartilage.
High tibial osteotomy can be an alternative to and/or delay of knee replacement surgery. This is a good option for young, healthy, and active patients with arthritis only in one part of the knee.
Preparing for Surgery
Your orthopaedic surgeon may suggest that you have a visit with your family doctor to prepare for your upcoming surgery. Your doctor may recommend that you begin to practice the exercises that you will need to do after surgery to help with your recovery. In addition, you should practice the best ways to use a walker or crutches.
Work with your doctor to think ahead about your rehabilitation time after surgery. You may need to have some additional help at home for a few weeks.
Your doctor may have you take some antibiotic medications before and after your surgery to help reduce the risk of infection.
Before your surgery day, your doctor may suggest that you donate some of your own blood so that it will be available if your body needs it during surgery. You can donate blood up to 5 weeks before your operation.
You should not have any skin infections or irritations on your leg at the time of surgery. Call you surgeon prior to the surgery if any of these problems occur. You should wash your leg with soap before going to the surgical center for your procedure.
You will probably need to be at the surgery center or hospital a couple of hours before your surgery. The nurses may give you an intravenous (IV) line so you can receive fluids and medications. You will be given anesthesia that will numb the knee area through the surgery.
The Procedure
After the anesthesia takes effect, the doctor will make an incision (cut) on the outside of your leg below the knee joint. A wedge of bone is removed from the tibia. The bone is then held together with either a plate and screws or staples. Occasionally, an external fixator (pins from the bone that are connected to a metal bar that sits outside of the skin) is used instead. After the procedure is completed, the doctor will close the incision with sutures or staples.
Recovery
After your surgery, you will have intravenous (IV) medications for about a day to help reduce the risk of infection, to help prevent blood clots, and to help control pain. Most patients do have some pain following surgery while their muscles and tissues heal. You will probably stay in the hospital between 1 day and 1 week.
Your doctor will decide when to take the bulky dressing off the knee and fit you with a brace. The brace will have hinges that let you bend your knee.
Once you are out of the hospital, you will need to walk with crutches, a cane, or a walker for 3 to 4 weeks to allow your tissues to heal from the surgery. You can put some weight on the leg, but how much is up to your doctor. Your doctor will also help you get involved in physical therapy to assist you with regaining motion and strength around the joint.
After 6 weeks, an X-ray will be taken to see how you are healing. If you are doing well, you will be able to put more weight on the leg. The brace may be discontinued at this time if your doctor is satisfied with your progress. Most high tibial osteotomy patients have swelling for 3 to 6 months after surgery.
Starting an exercise program will help with the recovery process. Talk with your doctor about the best exercise program to help your recovery process. Swimming and walking are exercises that will put minimal stress on your knees and will help you regain strength and improve your overall health. You probably will be advised against doing activities (such as running and tennis) that put a lot of stress on your knees. The pain that was present prior to surgery often begins to reduce in 4 to 6 months.
Complications
The complication rate following high tibial osteotomy is low. Fewer than one percent of patients develop a major complication. Talk with your doctor before surgery about the risks of high tibial osteotomy surgery.
Some of the risks include infection, poor skin healing, joint stiffness, non-union(failure of the bones to heal), loss of fixation due to position of the bones, failure to fully reduce the pain from arthritis, nerve injury, blood vessel injury, and deep vein thrombosis (DVT) or blood clots.
DVTs most commonly develop in the calves. The clot may extend into the thighs or pelvis. If a portion of the blood clot breaks loose, it may travel in your veins to your lungs and get caught there. This can block blood flow in the lungs. This is called a pulmonary embolism and can be dangerous. To prevent this, your doctor may put you on a blood thinning medication that will prevent the clots from forming. You can also wear compression stockings on your legs that will decrease the risk of DVT.