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.

Caroline

Patient

"My problem began with a road accident 36 years ago – broken Tibia, Fibula, dislocated knee, damaged ankle, torn ligaments etc. Post operations my leg was not straight, resulting in undue pressure on the inside of my knee for many years. I had started to get trouble about 10 years ago and had all sorts of treatments to keep me active until a couple of years ago.

I was recommended to Professor Wilson by the wonderful consultant Mr Raman Dega, who was recommended by two friends.

I honestly didn’t think it would be such a long process from start to finish - approximately 18 months . Patience isn’t my strong point 😊 I was never in doubt though that this would make my life so much better in the long run it just takes time to get your head around and plan for. My expectations were that best case I wouldn't need a knee a partial knee replacement for a few more years and to be able to live an active life pain free. The worst case was at least my leg would be straight for the partial knee replacement which would give it more chance for success to again have an active life.

My expectations have been met but I am still in the process, next X-ray is July when I am hoping the bone has healed sufficiently to plan for removing the metal plate currently holding it all together. There is a fine line between pushing your limits in rehab and over doing it. I have had a couple of set-backs due to my inability to recognise when I pushed myself too far. However, I would encourage being diligent about exercise post op and getting lots of rest. Following the advice of the Professor and hospital staff, getting a good physio and following a program of rehab has without a doubt been a real boost to my recovery. Luke at Go-Perform in Reading is the best physio I have ever worked with. I also did everything I could to accelerate recovery from hiring a game ready at home post op for a month (recommended by Prof Wilson) to signing up for Apos therapy. I went back to Pilates of Berkshire 2 weeks after my op where Michelle Scully helped me keep myself fit without any risk to my leg.

From the very beginning Professor Adrian Wilson was very clear about the risks and benefits of this operation and I felt very confident that this was the right course of action for me. He is the expert in this field and was recommended by another consultant Raman Dega, who I know and trust. The professor is clearly passionate about his work and is constantly striving to improve techniques. He instilled confidence not only in his ability and expertise but also that I was a good candidate for the operation to be a success. If anyone is contemplating this operation I would highly recommend that they book a consultation with Prof Adrian Wilson."

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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