Have you ever come across the term osteotomy? It’s a relatively familiar word. But not particularly well understood.
Here’s a quick (fictional) story to help explain the concept.
Sarah’s knee problem
Sarah is in her mid-50s. She’s active. She likes to garden and go for long walks with friends. In her 20s and 30s, she was a keen marathon runner. About a year ago, however, she began to feel some discomfort in her knee. She dismissed it at first. But over the coming weeks the pain got steadily worse. It seemed to be particularly bad on the inside of her knee, running down the side of her leg. Eventually, she was barely able to walk. In desperation, she booked an appointment with a knee consultant, who examined her, ordered some scans – and diagnosed early-stage arthritis damage to the inside of her knee joint. The answer, said the consultant, could be an osteotomy.
OK, so what’s an osteotomy?
Put simply, an osteotomy is an operation to relieve pressure on a part of a knee that has become damaged by osteoarthritis. As you may know, osteoarthritis is when the cartilage on our knee joint gets worn away. (It’s often called “wear-and-tear arthritis”, for this reason.) If you suffer a bad knee injury, or if you have a leg alignment that puts unusual pressure on one part of your knee, your joint may be more susceptible to wear than normal. Over time, the cartilage in that knee compartment breaks down. And, perhaps years down the line, you start to get pain and swelling as your knee informs you that something isn’t quite right.
How does the operation work?
Think again about that pinch-point in Sarah’s knee. It’s not spread across the whole of her knee. It’s in one specific side of her joint. If you could just raise the point of highest contact away from the bone, the body weight would shift to the healthier part of the joint and that pressure would disappear. And this is what an osteotomy does. By cutting a small wedge of bone near your knee, we can alter the alignment of your leg and shift the pressure zones in your knee. Meaning the pressure no longer runs like a plumbline through that painful pinch-point.
How do you perform the surgery?
There are actually two forms of osteotomy. The most common is an opening wedge. As the name implies, this involves making a small cut in the bone of the leg before gently opening it up. The gap created is then filled with a graft, to encourage healing. This could be a piece of donated bone, for example from a hip replacement. Or a piece of your own bone (usually taken from the iliac crest in the hip). Or a synthetic graft, which is what we normally use here at Chris Bailey Orthopaedics. We then place a plate over the graft. This provides stability and structure for the new alignment. A closing wedge osteotomy is essentially the reverse. Bone is removed to close down the alignment angle, but there’s no graft.
Does it take a long time to recover from an osteotomy?
It varies from patient to patient. As a rule of thumb, we expect most people to be able to bear weight on their knee about six weeks after the procedure. You’ll be on crutches at first. We may also ask you to wear a hinged knee brace to give your leg support and to help you to bend it and move around. Around the six-week mark, we’ll take an x-ray of your leg to check it’s healing well and developing as expected. To get the best possible recovery, it’s important to build strength in your legs with regular, physiotherapy-recommended exercises. These will also help you to maintain motion in your knee, and stop things from seizing up. We’ll give you a comprehensive list of tailored exercises to go home with after your operation.
If you’re worried about your knees – or experiencing pain, stiffness or other problems in your joints – it’s always a good idea to get them properly looked at. You can book an appointment with Mr Bailey through our website, or call us direct on 01962 826107. We’ll be really pleased to get you the help you need.