Limb Realignment In Nashik

Limb Realignment

An Osteotomy is an operation which changes the alignment of the leg. This can be done for several reasons, though the most common is take pressure of a damaged, or arthritic, part of the knee in order to relieve pain and restore function without resorting to a knee replacement. It is commonly performed in young, active patients who are developing arthritis in a localised part of the knee and wish to remain active. It is used to relieve pain and to slow the progression of the arthritis, as well as allowing for the resumption of all activities without the restrictions imposed by a knee replacement. Occasionally an osteotomy is used to treat complex knee instability, and in association with cartilage repair or regeneration techniques.

What is an Osteotomy and how is it performed

Osteotomy literally means to “cut bone”. After careful preoperative planning one of the bones near the knee (usually the tibia or leg bone, but occasionally the femur or thigh bone) is precisely cut using a small saw to create an incomplete fracture. This cut is then slowly opened to create a wedge, the size of which determines the exact amount of correction. A small plate and screws is then used to hold the bone in place whilst it heals, and in many cases a bone graft is inserted into the created wedge to facilitate this healing process.

Day of surgery and recovery

The operation is generally performed under a general anaesthetic and takes between 60 and 90 minutes. The leg will be placed in a special brace at the conclusion of the surgery which allows controlled movement of the knee whilst supporting the osteotomy. The brace is worn for 6 week and patients are allowed to partially bear weight during this period.

Physiotherapy

Immediately after the surgery some simple exercises are taught to help start the process of rehabilitation, and these can be performed at home. A specific program with a physiotherapist will be commenced 6 weeks after surgery, once sufficient healing has occurred to allow weight bearing. The aim of this program will be to regain the full movement of the knee, and the strength of the muscles around it.

Results

High tibial osteotomy generally results in good relief from pain and improvement in function. The majority of patients (over 90%) feel that their knee is much improved after an osteotomy. The improvement following osteotomy lasts a variable amount of time, though for over 70% of patients the improvement lasts for 10 years or more. There is currently no cure for arthritis and the aim of this operation is not to try to reverse the damage but rather to slow its progression and to improve function by minimising pain.

What happens if the knee gets painful again?

As discussed above the osteotomy does not reverse the arthritic process within the knee, but rather unloads the damaged part of the knee allowing the more normal parts of the knee to take more of the load. Over time these parts of the knee can also slowly wear out (the most common cause of an osteotomy ceasing to be of benefit are the other parts of the knee developing arthritis). Hopefully this occurs 10 or more years after the initial surgery by which time the activity profile of most patients has changed somewhat. When this occurs a total knee replacement can then be performed, with the patient then gaining all the benefits of knee replacement in an arthritic knee. Whilst performing a knee replacement in a patient who has previously had an osteotomy may be slightly more difficult than performing one in a patient who has had no previous surgery, the majority are very successful and it has better results than redoing a previous knee replacement which has worn out and needs redoing.

Advantages of an osteotomy

  • Osteotomy is generally recommended when the patient is young (generally less than 50 years old). Whilst knee replacements are very effective at relieving pain, they do not last forever. Though over 90% of knee replacements will last more than 10 years these young patients with knee arthritis are going to live a lot longer than that. By performing the osteotomy in these young patients their own, native knee is preserved for longer, and the older the patient is when it finally does come time for the replacement, the more likely the replacement will last the remainder of the patients life
  • Osteotomy is recommended when the patient is active. Weather this be their job requirements, or their recreational and sporting activities, if a patient wishes to continue with an active lifestyle an osteotomy may be a better option than a replacement. Knee replacements are very effective at relieving pain and regaining mobility and function that has been lost to arthritis. However they are not designed for vigorous manual labour, or high demand sporting activity. These activities may not be possible after a knee replacement, and even if they are they are not recommended as they will decrease the longevity of the replacement making it more likely that it would wear out sooner and need to be redone.  Osteotomy allows for maintenance of a more “normal” knee and the activities that go along with it.
  • If the osteotomy does eventually wear out the option for knee replacement remains. Performing a knee replacement on a patient who has previously had an osteotomy is easier and more effective than redoing a knee replacement which has worn out. An osteotomy does not “burn any bridges” and leaves the option for knee replacement if it should be needed in the future.

In summary an osteotomy “buys time”, allows the patient to remain as active as they wish, and preserves their own native knee for as long as possible. When (and if) the time comes, a knee replacement can still be performed with excellent results, and some patients will never need to progress to a knee replacement.

Risks

All operations have some risk. Those specific include (but are not limited to):

Incomplete bone healing

In a small percentage (less than 5%) of patients the bone may not fully heal, or may change position whilst healing. This is monitored by the progress Xray, and in the rare case where it is necessary a second surgery may be required to promote complete healing.

Blood clots

Deep venous thrombosis can occur after any surgery, and is more common after Orthopaedic procedures including osteotomy. All precautions are taken to avoid their occurrence including stockings, calf pumps, and medications. If a blood clot does occur it can generally be treated by medications.

Nerve and blood vessel injury

The major nerves and blood vessels supplying the leg are in the vicinity of the surgery and can rarely be injured. All care is taken to avoid these structures.

Infection

Infection can occur after any surgical procedure. It is uncommon after osteotomy, though possible, and antibiotics are given during the procedure to decrease it risk.

Summary

Osteotomy is a very useful technique for preserving function in the young active patient who is developing arthritis. This procedure is specifically recommended for young patients with osteoarthritis in whom total knee replacement is not suitable.

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