Osteotomy

/Osteotomy
Osteotomy2018-09-09T11:25:33+00:00

What are the osteotomies?

The osteotomies are procedures aiming to correct lower limb malalignments. The importance of a proper limb alignment is very frequently understimate. It is very common to see patients presenting with one or more MRIs indicating a torn meniscus, when the meniscus is a victim more than the cause of the problem in many cases. It is always necessary to assess the alignment of the lower extremities because an alteration of it can be a reason for a very bad outcome if it is not corrected or contemplated prior to resecting a meniscus.

A knee osteotomy is a surgical procedure that it is performed on patients who have only one affected compartment of the knee, usually in the medial or internal region of the joint. The main objective of this surgery is to improve function, reduce pain and delay the need for a knee prosthesis. That means to lengthen the useful life of the joint. This is achieved by correcting the axis of the affected lower limb, displacing the weight load to areas of the knee that are healthy. Thus, the weight bearing area compromised by osteoarthritis is lightened.

Surgery

A knee arthroscopy is first performed to assess possible associated injuries and treats them when necessary. Then the osteotomy itself is done. There are two main techniques to be performed depending on the patient’s prior deformity and other conditions:

The most common are knee valgus osteotomy. They are conducted at the level of the upper tibia. The deformity correction is most frequently obtained by adding a wedge in the medial or inner zone (open wedge osteotomy). It can also be done by subtracting a wedge on the side or outer zone (closed wedge osteotomy), but this carries a higher risk of complications.

The indication for it depends on several factors to be considered and explained in the consultation. In most cases Dr. Gelber prefers the addition osteotomy technique for its greater precision and lower complication rate. Usually, the patient should remain in the center for between 2 and 4 days after surgery for proper pain control and the immediate start of rehabilitation.

After surgery

After surgery on the day of hospital discharge and before leaving for home, the patient receives all necessary information regarding postoperative care see post-operative care. The patient also leaves the hospital with an appointment for within 10 days or so to have the wound checked and have the stitches removed.

Rehabilitation

The main difference from the standpoint of rehabilitation between the two main types of osteotomies is that subtraction osteotomy allows for immediate weight-bearing of the limb, while the must frequently performed addition osteotomy requires to protect the weight bearing for 2 weeks. In general, the patient can definitely stop using the crutches between 4 and 6 weeks after surgery in these cases. In the other aspects of rehabilitation, all osteotomies seek the same goal, such as decreasing inflammation, the recovery of full mobility of the knee with special emphasis on extension and regaining strength and muscle tone. Most patients achieve a 70% of their functional improvement at 2 or 3 months and almost complete functional recovery between 3 and 6 months, although some additional progress is to be expected until one year of the intervention.

Postoperative exercises after a knee osteotomy depend on whether the osteotomy was performed on the tibia or on the femur and whether it was a closed wedge (bone removal) or open wedge (bone addition) osteotomy. Ultimately, it depends on possible associated surgery of menisci, cartilage or ligaments (recommendations should always be combined with the more conservative prevailing).

First general phase

Control of pain and inflammation

One notices that the knee is sore and swollen the first few days. To improve this, the recommendation is:

  • Keep the leg elevated as much as possible.
  • Apply ice for 15 minutes 4 or 5 times a day.
  • Take the recommended anti-inflammatory and analgesic drugs.
  • Use medication prescribed as rescue if there is severe pain.

Open wedge high TIBIAL valgus osteotomy

  • Motion: without restrictions, increase progressively In the case of meniscal repair or replacement, do not exceed 90º until week 6.
  • Load: Non-weightbearing for about 2 weeks (must be individualized). In case of cartilage treatment, until week 6.

  • General strengthening exercises.
  • Gradual progression of all these recommendations to avoid pain that limits recovery.

Open wedge distal FEMORAL varus osteotomy

  • Motion: In the case of meniscal repair or replacement, do not exceed 90º until week 6.
  • Load: Non-weightbearing for about 8-10 weeks (must be individualized).
  • General strengthening exercises.
  • Gradual progression of all these recommendations to avoid pain that limits recovery.