Minimally-invasive Osteotomy for DFO and HTO

Minimally-invasive osteotomy allows patients to weight-bear in the first week after a high tibial osteotomy.

This new technique is a far less painful procedure than traditional high tibial osteotomy. The minimally invasive approach involves a 3½ to 4 centimetre incision and a very careful dissection (minimal dissection actually). The saw cuts are made with a precision saw blade. Then the bone wedge is important in offering immediate stability.

Minimal pain and swelling

Many patients do not even need paracetamol. The reasons for this include:

  • The technique is truly minimally invasive, so there is far less soft tissue disruption
  • At the end of the procedure the surgeon injects large volumes of long acting local anaesthetic into the wound
  • There little swelling because of the bone wedge used to fill the bony gap created as part of the procedure
  • Swelling is further minimised with a Game Ready device, which I use as a routine after all my major cases. The Game Ready is a pressurised cryotherapy cuff which is applied in the operating theatre immediately after the procedure. It runs a 20 minute cycle of ice cold cryotherapy under pressure.

Rapid weight-bearing after this minimally-invasive procedure changes the entire outlook of the rehabilitation period.

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One of the other real passions in my life as a knee surgeon is in the field of osteotomy surgery where I am probably best known worldwide.

Osteotomy is an operation that really fell off the radar, but in its new form - which we are refining all the time. We are finding that our patients with painful alignment problems are really getting fantastic results by our doing small off­loading procedures through what I like to describe as my 'minimally-invasive' technique.

In this surgery we use a very precise technique both to measure and carry out the osteotomy, and we are able to do this through really tiny incisions. Many of our patients are saying that they are feeling no pain whatsoever after this procedure and its applications are widening all the time in terms of who we think can benefit from this procedure.

We set Basingstoke up as a European, and now World, centre for this, where surgeons from all over Europe and in fact further afield come to our Masterclass once a year - where we teach surgeons. A group of my friends, who are really the leading osteotomy surgeons in Europe, gather in Basingstoke and we run a 2-day course. Id I’m delighted to say that our recent 8th Masterclass was our best and greatest success, and we are just happy to have taught what we have learnt ourselves over the last decade to our colleagues both in the UK and elsewhere.

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