HTO
Osteoarthritis of the knee
When osteoarthritis occurs in the knee, the articular cartilage becomes rough and
thin and can wear down to expose the underlying bone. Articular cartilage is a layer
of firm, slippery material that covers the ends of bones which make up joints. In the
knee joint there is articular cartilage on the end of the femur (thigh bone), the top of
the tibia (shin bone) and the back of the patella (knee cap). The bone at the edge of
your joint can grow outwards forming bony spurs called osteophytes.
The knee may swell and becomes gradually more painful over time.
If the knee joint is mal‑aligned then abnormal forces cause excessive pressure on
either the medial (inner) or the lateral (outer) aspect of the knee. Osteoarthritis in a
mal-aligned knee can mean that while one side of the knee joint is damaged, the
other side is relatively well preserved.
In your case, the medial aspect of your knee is damaged by osteoarthritis. You may
be aware that your leg has become more bowed and this may impair your walking
ability and cause pain even when at rest.
What is a high tibial osteotomy?
An osteotomy is a surgical operation whereby a bone is cut to alter its length or
change its alignment. A high tibial osteotomy involves cutting into the tibia below the
painful side of your knee and wedging open a large enough gap to re-align the lower
leg. A metal plate is used to hold open the gap and is held in situ with screws. Over
time your own bone will grow into the gap.
Often, a keyhole examination of the knee (arthroscopy) will precede the osteotomy to
make a final assessment of the knee joint, under the same anaesthetic.
The main aim of a high tibial osteotomy is to shift your body weight off the damaged
area of your knee to the lateral side where the cartilage is still healthy. This in turn is
intended to relieve your knee pain and should improve your walking pattern and
function.
Unfortunately a high tibial osteotomy will not return your knee to normal. It is
generally considered a method of prolonging the time before a knee replacement is
necessary, as the benefits typically fade after eight to ten years, but can last longer.
All operations involve an element of risk:
* Potential complications from a high tibial osteotomy include residual osteoarthritis
symptoms (such as stiffness or swelling), tibial fracture, delayed or non-healing of
the osteotomy or pain from the metal plate (which may need later removal).
* Uncommon problems include infection and blood clot (otherwise known as deep
vein thrombosis or DVT);
* Rare but potentially serious problems include nerve or blood vessel injury;
* Minor complications relating to the anaesthetic such as sickness and nausea are
relatively common. Heart, lung or nervous system problems are much less common.
The intended benefits of high tibial osteotomy surgery are to:
* Correct poor alignment of the knee
* Prolong the life of the knee joint, delaying the need for Total Knee Replacement
surgery. In some patients, knee replacement may be avoided
* Reduce pain
* Improve function
* Improve quality of life
Frequently Asked Questions
Do I need to do exercise ?
Yes. It is important to start getting the knee moving but in a controlled manner. The
Physiotherapist will show you the exercises you will need to start with. These will be
progressed as you are physically able under the guidance of your physiotherapist.
You will be referred for continued physiotherapy as an out‑patient and it is essential
that you are seen within one week of your operation.
Will I need to use crutches?
You will be provided with a pair of crutches for use when walking. Unless you have
been instructed otherwise, due to more complex surgery (such as a cartilage repair
in addition to your meniscus repair) the crutches are used for comfort. You can
gradually decrease their use as comfort allows. It is important that you take the
weight through your leg in the correct manner i.e. putting the heel down first.
What do I do about the wound?
When you are discharged from hospital you’ll have a compression bandage on your
knee that should remain in place for 24‑48 hours. After this time, remove the bandage
and change the small plaster dressings underneath if they are blood‑stained. Wash
your hands carefully before changing dressings to prevent infection. Keep your
wound clean and dry until it is fully healed. Stitches, clips or steri‑strips will need
removing, which is usually usually carried out between 10 and 14 days after your
operation. The wound remains covered with the dressings until the
stitches/clips/steri‑strips are removed. You may shower before the removal of the
stitches/clips/steri‑strips — you will need to wrap the knee in cling film until then; pat
dry, don’t rub.
When do I return to the outpatient clinic?
When you are discharged from hospital you’ll have a compression bandage on your
knee that should remain in place for 24‑48 hours. After this time, remove the bandage
and change the small plaster dressings underneath if they are blood‑stained. Wash
your hands carefully before changing dressings to prevent infection. Keep your
wound clean and dry until it is fully healed. Stitches, clips or steri‑strips will need
removing, which is usually usually carried out between 10 and 14 days after your
operation. The wound remains covered with the dressings until the
stitches/clips/steri‑strips are removed. You may shower before the removal of the
stitches/clips/steri‑strips — you will need to wrap the knee in cling film until then; pat
dry, don’t rub.
Are there things that I should avoid doing?
To protect the osteotomy while healing you will need to avoid putting too much
stress through the knee. Avoid twisting, turning or pivoting manoeuvres on your
operated leg; avoid full‑leg extensions when seated; avoid standing for prolonged
periods early on (which may increase swelling). Use crutches and walk heel‑first,
avoid walking on a bent knee or with a limp.