Gait problems due to varus after meniscectomy

walking

Mark is a 51year old physiotherapist who owns a very large practice in Putney. He is a very active gentleman who has done a lot of work with the army and the armed forces. He enjoys skiing and hiking and continues to be very active in terms of his day to day life.

Mark has had an arthroscopic meniscectomy in the past. He has had a total of 6 injections into the knee for pain. Over the last few years he has noticed increasing issues with instability in his knee and he started to develop a very bowed leg on the right which is making it difficult for him to walk. He went and saw many surgeons, some of them very well known, in London and my name kept on popping up so he tracked me down approximately 6 months ago.

Varus right knee

When we first met I assessed him and found him to be in really very severe right-sided varus which had caused quite a lot of pseudolaxity of the ligaments around the knee. He ticked all the boxes for an osteotomy given that he had quite significant wear and tear on the inside of his knee, and on the outside the lateral compartment and the patellofemoral joint were both good.

We talked about osteotomy surgery and I went in pros and cons, and this was something he clearly wanted to persue.

varus alignment long leg x-rays

I actually went up to see him in Putney and have a look at his unit. He walked me down to the station and he was really walking a bit like John Wayne as he had this very severe varus thrust. Every time he took a step his knees fell into a more bowed position, making him walk with a very awkward gait. He was limping after 100 metres.

Osteotomy surgery

I got him in for surgery in January - he was one of the first cases of the year - and things went very well.

planning the osteotomy

The computer planning on the
long-leg X-ray

high tibial osteotomy

The actual post-operative result with the plate in situ

He stayed in for a day or two and was then discharged and has been working very hard on his rehab ever since.

Follow-up

I am delighted to say that just three months down the line his osteotomy is almost completely healed, so if I wanted to I could pretty much take the plate out now, which is not that surprising given that with the bone wedge technique that I have developed many patients do heal up at three to four months - without the bone wedge it is 12-18 months before the osteotomies are fully united. He had a beautifully straight leg today when I examined him and walks with a completely normal gait. All that swaggering that was there prior to January is now gone. He has got full extension, excellent flexion, he has healed up very well and his post-op X-ray looks spot on. I am also very happy with the alignment X-rays.

I am delighted that he has done so well. He has come through with minimal pain and he looks so well rehabilitated at this early stage today when I reviewed him in Clinic.​

adrian wilson

Adrian Wilson


As a physiotherapist Mark sees many patients himself who had failed meniscal surgery - patients who are young and active such as himself who are told either that there is nothing that can be done or a knee replacement sometime in the future. The message really needs to get out that there is an option, and that option is osteotomy surgery.


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