The value of biplanar osteotomy

Neil was referred to me by Steve Bollen, who is a very well known surgeon in Yorkshire who has been a leading light in sports knee surgery for many years.

Mr Bollen has several times seen me talk on osteotomy and in particular about my minimally invasive technique and the use of a bone wedge as part of that procedure. He has been looking after Neil for some time, and decided to refer him to me with a view to osteotomy.

Neil came down to see me, and at 54 was really perfect in terms of indications. He was doing a 'half-ironman' a year before the surgery but developed sudden onset right medial knee pain with no precipitating trauma. He had constant discomfort and swelling after this which was particularly bad with activity.

He had remained very active and was able to walk up to 10 miles a day with his dog but was taking ibuprofen and paracetamol and always had a limp. He also noticed that he could not straighten the knee.

Bi-planar deformity

I saw that he had quite significant varus, was tender medially and had a fixed flexion deformity.

One of the big benefits of the osteotomy technique, particularly the bi-planar technique, is that we can actually get rid of fixed flexion deformity as well as varus, so we can re-align in two planes - getting the knee straight such that one can fully extend it as well as making the leg look straight from the front.

In fact his surgery went very well and I was impressed that he was actually able to leave hospital within two days of having the procedure. He reported absolutely no pain and on getting back to his home in Yorkshire he decided that he was actually so pain-free that he would walk on a treadmill half a mile a day! He soon worked out that this probably was not the best thing as he developed some discomfort. It is important after this surgery that patients take it easy for two weeks and rest the knee as best they can. After this they then obviously increase their activity levels.

He is doing very well at the two-week stage and I am delighted to hear that he felt confident enough to go on the treadmill for half a mile within a day or two of surgery. I think that this is a testament to the new technique.

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