Knee osteotomy (realignment surgery)


What is involved?

Knee osteotomy involves realigning the axis of the leg to take pressure off part of the knee joint that is worn or damaged.  The thigh bone or shin bone is carefully divided in a planned fashion and fixed in a new position with specialised plates and screws. This means that a previously bowed or knock-kneed leg can be realigned and straightened to allow the body weight to be evenly distributed through the knee joint, relieving pressure on damaged tissue.  This helps preserve the knee joint which improves both the symptoms and reduces the onset of arthritis in the knee, postponing the need for replacement surgery in the future.

Specialised x-rays and scans allow precise planning of the surgery and we will often use bespoke computer-designed and 3D printed cutting guides to correct the abnormalities in your knee as accurately as possible.


Why might I need an Osteotomy? 

An osteotomy is normally carried out when you have wear and tear or arthritis in one section of your knee joint. The procedure is more effective in people who have earlier degenerative change than fully established bone-on-bone arthritis.  The procedure is normally carried out in people who have malalignment of their legs, leading to certain patterns of arthritis. 

1) Bow-legged deformity - if you have varus (bow-legged) knees, more of your body weight is transferred through the inner side (medial) part of your knee joint.  An osteotomy in the proximal part of your tibia (shin bone) to open a wedge and realign the knee will relieve pressure on this section of the knee. 

2) Knock-kneed - if you have valgus (knock-kneed) legs, you may develop arthritis on the outer side (lateral) part of your knee.  In this setting a distal femoral osteotomy where the bottom part of your thigh bone is realigned will straighten the leg and put more weight through the less damaged medial part of your knee.


What happens after surgery?

Following surgery you will be managed initially by our expert physiotherapy team on the ward.  They will provide you with appropriate analgesia and your knee will be wrapped in a state of the art cooling device to reduce swelling and pain. The method of osteotomy used is such that we will encourage you to bear weight as much as is comfortable immediately following surgery.  This will normally require the aid of crutches for a few weeks.  Once you are safe and have recovered from the anaesthetic, you will be able to be discharged home. This is normally on the same day or the day after surgery.  You will then be followed up in the community by appropriate physiotherapists to help regain your range movement and strength in your knee and reviewed by your surgeon initially at two and six weeks to ensure you are progressing as we would hope. 


Recovery milestones:

Weeks 0-2: Over this period of time appropriate analgesia and ice treatment is used to reduce the pain and swelling in your knee and allow you to regain a full range of movement.  You will be weight bearing as pain allows on crutches.

Weeks 2-6: Over this period of time the osteotomy within the bone and the small gap in the bone that results from this will heal and solid new bone will form across the gap.  At approximately six weeks an x-ray will be taken to confirm that the bone is healing and you can wean off crutches as pain allows. 

Weeks 6-12: Over this period of time you will begin to walk more normally without a limp and you can begin to return to demanding activities as tolerated.

Weeks 12 onwards: We would aim for you to return to full activity at a time and rate appropriate to your particular case.  One of the benefits of an osteotomy is that you should be able to return to high impact sporting actives that some patients following knee replacement surgery find difficult. 


Frequently asked questions 

What are the advantages of knee osteotomy over knee replacement?

Osteotomy is appropriate in cases where arthritis has not affected the entirety of the knee joint and therefore removal of undamaged tissue would be required to perform knee replacement surgery.  Osteotomies are normally more beneficial in younger more active patients who want to get back to high impact activities. Osteotomy means we can reduce the pain in your knee without a replacement this can lead to an improved range of movement and long-term function in your knee.  Osteotomy can delay the requirement of knee replacement surgery or in some cases avoid the need for replacement surgery all together. 

How long does it take to recover from knee osteotomies? 

Most people are able to bear their own weight within 24 hours but full rehabilitation to walking without crutches normally takes approximately 12 weeks.  

When will I be able to return to work?

Most people will be able to return to work within six weeks of surgery.  People with more manual jobs may require 12 weeks off work. 

When can I return to sport?

One of the benefits of a knee osteotomy is to allow a return to a higher level of sport and activity than one might normally consider feasible following knee replacement surgery.  Return to competitive sport is normally between 6-12 months post-surgery. 

Will the plate have to be removed?

Following healing of the osteotomy, dependent on your particular circumstances, it may be recommended to have the plate and screws removed to prevent further complications should you require knee replacement surgery at a later stage.