Bow-legs are known medically as 'varus deformity'. In this case presentation the patient himself takes you through his osteotomy experience after he had struggled for some years with bilateral varus deformity.
This gentleman was always very active, especially in martial arts, and by the age of 26 he had earned a Black Belt in Tae kwon do. There was never any major knee injury but over the years multiple small insults took their toll, and at age 33 he was experiencing incidents of locking in his knees. At that stage he had an arthroscopic 'clean up' of the menisci.
Subsequent deterioration of both joints on their inner aspect, relating to the meniscus damage, resulted in marked bow-legs, and debilitating pain. At the age of 44 he was referred to Professor Wilson for consideration for osteotomy. It was decided not to tackle both knees at the same time, and in February 2015 he underwent a corrective osteotomy on the right knee.
On the left of this image you see the long-leg standing X-ray of the limbs at the beginning of the surgical planning. You can see the degree of bowing in both legs. The picture on the right is actually the same X-ray, but it shows the computer calculation of the amount of bone wedging that would be necessary to straighten his left leg (the image with the green lines) in the first osteotomy.
Right leg. February 2015.
High tibial osteotomy (large wedge) (PEEK plate)
This period of rehabilitation was a bit challenging. Firstly the long period of limited mobility meant that the muscles were weak. Then there was a complication of a superficial infection that required aggressive treatment to prevent infection going into the bone. After 7 months, the other leg was tackled. This time it was decided that the surgery would involve smaller re-alignments both above and blow the knee, rather the one large wedge that was done on the first knee.
First procedure - high tibial osteotomy on patient's right leg
Left leg. September 2015.
Distal femoral osteotomy plus High tibial osteotomy
After the second procedure on the patient's left leg. The plate is more evident on these films, because it is metal whereas in the first operation a PEEK plate was used, which is made of carbon fibre and is less dense to the X-ray beam.
The distal femoral osteotomy (DFO) is the procedure above the knee, and the high tibial osteotomies (HTO) are the procedures below the knee
Walking unaided at 3 weeks after the second osteotomy
Then after a year from the second osteotomy, a third operation involved the removal of all the hardware - the plates and screws that were holding the bones in their new alignment.
Both legs. September 2016.
Removal of all hardware
21st September 2016
"I am currently two weeks post op from having all my metal work removed, back in the gym already and managed 30 mins on a bike. This op has been truly amazing and life changing, I spoke to Professor Wilson today and said I would be more than happy to talk to anyone who has issues or concerns about going for this approach, even setting up some form of support group - so I’m really hoping the videos I took will make a massive difference to those out there."
Bow-legs may be corrected at the same time, or at different times, and a number of factors need to be taken into consideration:
(after 2nd osteotomy but before removal of hardware)
Progress with rehab exercises...
For more information see The osteotomy Expert Group website.