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High Tibial Osteotomy

Introduction

High tibial osteotomy is a surgical procedure performed to straighten the tibia (shin bone) and reduce uneven pressure and associated arthritic conditions in the knee joint.

Re-alignment of the tibia is usually recommended for younger patients who are highly active, and who still have sufficient healthy cartilage to bear the redistributed weight.

High tibial osteotomy is not generally a permanent alternative to total knee replacement, but it is an effective stop-gap procedure for those that want to maintain high activity levels for a few more years.

Long-term success levels in pain reduction and mobility improvement in high tibial osteotomy procedures are around 60-70% at ten years.

When is surgery necessary?

High tibial osteotomy is typically recommended in patients under 55 who have high activity levels (e.g. sports and labour-intensive work) who suffer severe arthritic pain in the knee that hasn't responded to non-surgical treatments such as medication, physiotherapy and knee supports.

The decision to operate

To determine whether you are a suitable candidate for this operation, Dr. Letchford will assess you according to a highly specific set of criteria.

He will only proceed with the operation if the damage is confined to one compartment of the knee joint, and if you still have functioning ligaments and adequate range of motion.

Before considering surgery, Dr. Letchford will consult with you, perform a physical examination and refer to recent scans and your medical history to establish whether or not it is the right choice for you.

In some cases, Dr. Letchford may choose to perform an arthroscopic inspection to more accurately survey your joint.

Helping you understand your options

Before deciding to go ahead with surgery, Dr. Letchford will take the time to talk with you about:

  • The outcome you want according to your current lifestyle and activity levels
  • The risks and benefits of surgery
  • The results you can expect

Dr. Letchford will only recommend surgery if both you and he are in agreement that it offers the best possible outcome for improving your pain and mobility issues.

About the procedure

What it involves

There are two methods of performing high tibial osteotomy: closing wedge and opening wedge. Both operations usually take around 2 hours.

In closing wedge osteotomy, a small sliver of bone is removed, whereas in opening wedge osteotomy, a small shim is inserted into the bone to widen the angle. Dr. Letchford will choose whichever treatment better suits your condition, symptoms and gait.

  • You will be given general anaesthetic to put you to sleep or spinal anaesthesia to numb you from the waist down, and preventative antibiotics to protect against infection.
  • A tourniquet is place on your thigh to limit blood loss.
  • An incision is made over the relevant area of the tibia.
  • A small wedge is either inserted or removed from the tibia, with repeated x-rays and visual measurements taken to ensure correct realignment.
  • In some situations, a small amount of bone from the fibula (calf bone) also needs to be removed for best results.
  • A metal plate and screws will be inserted to hold the reformed bone in place until it heals.
  • The incision is closed. A drain may be inserted to remove fluid build-up.
  • Dr. Letchford may apply a cast or brace to protect the knee.

Hospital stay and recovery time

In-patient stay:          2-4 days
Walk (crutches):        Up to 6 weeks
Walk (unaided):        By 6 weeks (ideally)
Sports:                        3-6 months depending on healing

Possible risks and complications

Please note that all surgery brings with it risks and possible complications. However, as high tibial osteotomy is generally carried out on relatively young, active and healthy candidates, complications are rare.

The most likely complications – although still rare – are continued arthritic pain, infection, blood clots, stiffness in the knee, nerve or blood vessel damage, and failure for the osteotomy to heal properly.

Pre-operative checklist

Before you come in for your surgery, there are a number of things that both you and Dr. Letchford will need to do to ensure everything goes smoothly before and after the operation.

  • Existing medications

You should cease taking any blood-thinning or anti-inflammatory drugs, as well as any herbal or natural remedies you're taking, at least 10 days before your surgery.

  • Medical evaluation

You will undergo a routine medical examination to make sure you are in good enough health for the operation, and to identify any factors that might cause problems down the line, including body weight and existing infections or skin conditions.

  • Dental evaluation

Dental work can introduce bacteria into the bloodstream. To protect against the chance of developing an infection, please have any dental work done well before or after your surgery. You may need to take preventative antibiotics for a few months to a few years after your surgery to protect against the risk of infection.

  • Further tests and blood work

You will be sent for routine blood work to confirm you are healthy enough to undergo surgery. We may also perform heart checks or additional scans if the need arises.

  • Smoking

It is recommended that you stop smoking for as long as possible before your surgery, as it can encourage clots while hampering circulation and oxygenation of the blood.

Recovery, rehabilitation and precautions

  • Physiotherapy and exercise

Your physical therapist will work with you to stimulate healing and improve bone strength in the operated-on area. Full rehabilitation usually takes up to 6 months – during this time it is important to actively build motion and muscle strength around the knee.

  • Preventing infection

Make sure you change your dressing as instructed, and keep an eye out for any changes, including fever, chills, tenderness, excessive fluid, or increased pain, as these can indicate infection.

  • Preventing blood clots

You will be given a combination of anti-clotting drugs and pressure bandages to help prevent clots from forming. If you notice any shortness of breath or unexplained pain, contact a doctor immediately.

  • Staying nourished

You may experience some loss of appetite following surgery. To give yourself the best chance at a speedy recovery, try to eat a healthy, balanced diet and keep your fluid levels up.

Further information

For more information on what to expect from your total knee replacement surgery, please take the time to read through the resources available at the American Academy of Orthopaedic Surgeons website.