In younger patients with arthritis in the knee joint, a realignment procedure called the High Tibial Osteotomy (HTO) may be recommended to ease the pain and improve the alignment of the knee.
Osteotomy which means ‘cutting bone’, is a procedure where the surgeon cuts a bone in order to change the alignment.
When performing a HTO, this involves realigning the shin bone and the tibia. This is to take the pressure from the arthritic part of the knee and directing it to the normal part of the knee.
The surgeon will then carefully cut the tibia and insert a bone graft to help with healing. The osteotomy is further supported with a titanium plate that usually allows for immediate walking using crutches and a brace.
Whilst the knee arthritis will eventually progress and require definitive treatment with a knee replacement, the HTO procedure is quite useful for alleviating pain and allowing the patient to return to strenuous physical work that may not be otherwise possible with a Total Knee Replacement.
Diagnosis
To determine whether a patient is a suitable candidate for a HTO, long leg weight bearing X-rays need to be taken to determine the limb alignment. An MRI scan is also performed to confirm that the arthritis in the knee is confined to just one part of the knee.
A discussion with the surgeon about treatment options takes place and other considerations such as Total Knee Replacements and Partial Knee Replacements can also be considered.
Surgical Procedure
- The patient is anaesthetised, and the leg is washed in an antiseptic solution and draped.
- Keyhole surgery is performed to clean the knee of any arthritic cartilage damage and to confirm that the rest of the knee has enough adequate cartilage.
- A skin incision is made over the tibia and under X-ray control, the tibia is carefully cut using sharp chisels. Once complete, the sectioned bone is opened to the desired length and bone graft inserted. This realigns the leg. A titanium plate is then inserted to rigidly stabilise the osteotomy and allow for early weight bearing.
- The wound is washed and closed, and a dressing applied along with a range of motion brace.
- The patient goes to the ward and is allowed to mobilise the same day. Careful monitoring of leg blood flow and muscle function is performed in hospital care. Physiotherapy then takes place to ensure patients are safe to go home.
Rehabilitation
- Patients can go home in 48 hours, post-surgery. In first 2 weeks the leg is iced and rested to allow swelling and bruising to settle.
- Physiotherapy begins in first 6 weeks, during which time walking with crutches and a brace is allowed.
- Once adequate healing of the osteotomy is confirmed, at 6 weeks with an X-ray, the brace and crutches can be removed. Driving an automatic car can commence after 8 weeks for a right leg HTO and 4 weeks earlier for a left.
- After the first 6 weeks, the focus changes to increasing the range of movement and muscle strength in the leg. Hydrotherapy for recovery and rehabilitation is also useful during this time.
- The complete recovery can take 6 to 9 months and depends on the speed of bone healing and muscle recovery. In the future, the titanium plate may need to be removed particularly if future knee replacement surgery is to be undertaken.
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