Osteotomy

I have significant experience in this area, having introduced this group of operations to my NHS trust in 2015. The role of osteotomy is to treat ‘a failing and overloaded compartment.’ What this means usually, is that one side of your knee has developed pain and overload, but the other side remains well preserved. In these situations, an osteotomy can be considered as an option. This can be above or below your knee, and the aim would be to change the alignment of the leg and bring the bodyweight away from the painful side of your knee, and across to the well preserved side.

The following x-rays show that the joint space on the inside (medial) of the knee is narrowed.

x-rays show that the joint space on the inside (medial) of the knee is narrowed

X-rays that run from the hip to the ankle can show exactly where the bodyweight crosses the knee joints. Ideally it should be close to the centre of the joint. In the case below, it is crossing over the inside of the knee joints.

X-rays that run from the hip to the ankle can show exactly where the bodyweight crosses the knee joints

The correction required can be calculated and used to plan a corrective osteotomy. These generally come under the headings of high tibial osteotomy or distal femoral osteotomy. In severe cases they can be combined together.

The correction required can be calculated and used to plan a corrective osteotomy.

Over time, the bone will grow across the gap that has been created. At this point, the osteotomy has healed and the plate is no longer required. Often it can be left in, and as it is made of titanium, it is biologically inert. Sometimes patients elect to have it removed in a much smaller procedure. Below is an example of the osteotomy after it has healed.

Over time, the bone will grow across the gap that has been created.
Osteotomy after it has healed

This video clip is from my theatre. At this stage, I’ve created the osteotomy cuts, but I have carefully left the far side of the bone intact. You can see the way it springs open and closed.

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