Double level osteotomy on a consultant colleague

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Dimitri is a 51 year old consultant colleague who works as an anaesthetist.

He is very active but has problems in both knees, mostly the right knee where he has noticed a progressive bowing or varus deformity in his knee over the last few years. He has also developed sharp medial knee pain.

The MRI scan showed a significant medial meniscal tear and some early changes to the joint surfaces. As a lot of such patients go on to deteriorate rapidly after a meniscectomy, we talked about options and he elected to go for realignment surgery as well as the meniscectomy which was carried out in July 2017.

I think the videos, taken a day after surgery, speak for themselves.

Double Correction

He had a double correction with the new minimally-invasive technique - both femoral and tibial. The plates can be put in through very small incisions with minimal disruptions to the soft tissues, and with this minimally invasive approach patients can do very well - as you have just seen.The reason why I went for a double-level correction is because part of the deformity was in his femur and we know now from our work over the last five to ten years that it is very important that we don't over-simplify this and just correct in, say, the tibia for someone who has medial compartment varus osteoarthritis but we spread the correction out between both bones and do two small corrections rather than one large correction.

So here I've taken a wedge of bone out of the lateral (outer) side of the distal femur which has been fixed with the larger plate, and on the tibia - although it does not show particularly well on the X-ray (you can see it on the fluoroscopy images) - I've made a cut and done an 'opening-wedge' which was 8mm on the tibia and the 'closing-wedge' was 7 mm on the femur.I am very happy with how he is doing and with his post-operative X-rays.

adrian wilson

planning views for osteotomy

I am going to allow Dimitri to take 5-10 kilos of weight-bearing straight after surgery because of the femoral osteotomy and we will see him again in four weeks time. Really the video just shows how well people can do Day One despite these large interventions.

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