Realignment osteotomy for debilitating knee pain

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​Patients with early arthritis and early bowing can do extremely well from a realignment osteotomy.

This patient - Caroline - is a fit 54 year old lady who had an early failing medial compartment in her right leg (on the left of the X-ray) and was in varus (bowing of that leg). She was sent to me by a consultant colleague who knew about my interest in joint preservation and the management of early arthritis. She had severe medial knee pain, which was really debilitating her life.

varus deformity

You can see on this long-leg standing X-ray the change in alignment of the knee of the right leg (left of image). 

pre-op planning for osteotomy

This is the same X-ray but computer software has calculated the amount of opening of the bone wedge needed to correct the alignment.

The long leg X-rays and the MRI scans showed early failure of the medial compartment but a very nice looking lateral compartment, which indicated that the joint damage was confined to one side - perfect for an osteotomy correction.

High Tibial Osteotomy

Since her problems were all confined to the medial compartment of the right knee, we both agreed  that she would have a high tibial osteotomy under my care in July 2017. This was performed six weeks ago before this publication, and today she walked in for her follow-up appointment without her crutches.

Her original knee pain has all settled nicely and you can see from the video that she sent me that she is running extremely well on a gravity-reducing AlterG treadmill.

This is Caroline 6 months after osteotomy at 50% of her body weight on the anti gravity treadmill at Go-perform in Reading.

She tells me that she was able to walk 3 hours on holiday on Woolacombe Beach last week without any pain.This is a real testament to how far we have got with rapid rehabilitation following this procedure and I am delighted that Caroline has been able to get back to such a good level of activity with minimal discomfort.

All we need to do now is wait for this to fully consolidate and remove the plate and any residual symptoms will then settle. We can’t rush this so we don’t usually remove the plate for a minimum of 12 months following this procedure.

adrian wilson

Adrian Wilson


Below are the X-rays taken after the surgery:

HTO

X-ray view from the front showing the plate and screws holding open the wedge in the bone.

HTO

X-ray view from the side showing the plate and screws holding open the wedge in the bone.

HTO

This long leg X-ray at follow-up shows the leg reallgned in a good position

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