Knee Osteotomy and Realignment

High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are a group of procedures that change the alignment of the knee, redirecting weight transferring through the arthritic painful part of the knee, to a part of the knee with healthier cartilage to alleviate pain.

Dr Agolley is a knee surgeon on the Gold Coast who performs high tibial osteotomy and distal femoral osteotomy (knee realignment) as a knee joint preservation procedure for osteoarthritis of the knee.

An osteotomy does not cure or reverse arthritis, rather it is a procedure that ‘buy’s time’ for younger more active individuals, improving knee pain until such at time where you may require a knee replacement.

The reason for preserving your knee joint, is that prosthetic implants are able to tolerate only a certain amount of force and cycles of motion before they wear out or break. The forces generated by running and stair climbing frequently, in an active or working individual, would exceed the tolerance of a prosthetic knee replacement, leading to early failure.

What are the symptoms?

Pain is typically felt on the inside of the knee, along the joint line, and worse with walking, running and stairs. There may be cracking and crunching, and occasional giving way. Patients are typically in their 50s+, and may have lead an active youth or sustained an injury in the past requiring meniscal surgery.

What investigations will be required?

Plain x-rays that are taken while you are weight bearing are essential to the work-up, and additional x-rays are taken from the hips to the ankles to assess the weight bearing alignment are also requested. An MRI scan may be performed to support the diagnosis, and to assess the cartilage in other parts of the knee joint.

When Should I have Surgery?

Surgical treatment is recommended for the active individual with isolated arthritis of the knee joint, when non-surgical modalities have failed. Not everyone fits the criteria for an osteotomy, and Dr Agolley will discuss the options with you at your appointment.

The procedure and post-operative recovery

The specific type of procedure required during your knee osteotomy will be discussed with you prior to the procedure. In general it is more common to require a high tibial osteotomy rather than a distal femoral osteotomy. For most patients:

Your anaesthetist will perform general anaesthetic
2 small keyhole incisions are made over your knee to assess the damage in the knee
An incision is made over the tibia, and the bone exposed to make the osteotomy
The osteotomy is opened to realign the leg allowing weight to be transferred to the healthier part of the knee joint
Several measurements are made to confirm the correction
X-rays during surgery are used to help confirm the correction
The osteotomy is fixed, and any bone graft to the osteotomy site is performed
The surgical site is thoroughly cleaned and closed

The post-operative recovery consists of:

The majority of patients that have a knee osteotomy usually require 2-4 nights stay in hospital
Full range of motion and full weight bearing with crutches for 4-6 weeks
Sedentary work from 2-4 weeks
Back to running at 4-6 months pending bone healing

Specific precautions

There may be numbness around the surgical sites. This usually resolves quickly, but may persist for several weeks. Major nerve or blood vessel injury is uncommon. Blood clots in the legs and lungs are also extremely uncommon. Infection is very uncommon. Delayed union or non-union of the osteotomy site uncommon in non-smokers.