Knee Replacement

Osteotomy literally means "cutting of the bone." In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when you have early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting your weight off of the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in your arthritic knee.
Osteoarthritis can develop when the bones of your knee and leg do not line up properly. This can put extra stress on on either the inner (medial) or outer (lateral) side of your knee. Over time, this extra pressure can wear away the smooth cartilage that protects the bones, causing pain and stiffness in your knee. (Left) A normal knee joint with healthy cartilage. (Right) Osteoarthritis that has damaged just one side of the knee joint. Advantages and Disadvantages Knee osteotomy has three goals: To transfer weight from the arthritic part of the knee to a healthier area To correct poor knee alignment To prolong the life span of the knee joint By preserving your own knee anatomy, a successful osteotomy may delay the need for a joint replacement for several years. Another advantage is that there are no restrictions on physical activities after an osteotomy - you will be able to comfortably participate in your favorite activities, even high impact exercise. Osteotomy does have disadvantages. For example, pain relief is not as predictable after osteotomy compared with a partial or total knee replacement. Because you cannot put your weight on your leg after osteotomy, it takes longer to recover from an osteotomy procedure than a partial knee replacement. In some cases, having had an osteotomy can make later knee replacement surgery more challenging. The recovery is typically more difficult than a partial knee replacement because of pain and not being able to put weight on the leg. Because results from total knee replacement and partial knee replacement have been so successful, knee osteotomy has become less common. Nevertheless, it remains an option for many patients.
Procedure
Most osteotomies for knee arthritis are done on the tibia (shinbone) to correct a bowlegged alignment that is putting too much stress on the inside of the knee. (Left) This x-ray of a healthy knee shows the normal joint space between the tibia and femur. (Right) In this x-ray, osteoarthritis has damaged the inside portion of the knee. The tibia and femur are rubbing against each other, causing pain (blue arrow). During this procedure, a wedge of bone is removed from the outside of the tibia, under the healthy side of the knee. When the surgeon closes the wedge, it straightens the leg. This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the damaged, arthritic side. As a result, the knee can carry weight more evenly, easing pressure on the painful side. In a tibial osteotomy, a wedge of bone is removed to straighten out the leg. Tibial osteotomy was first performed in Europe in the late 1950s and brought to the United States in the 1960s. This procedure is sometimes called a "high tibial osteotomy." Osteotomies of the thighbone (femur) are done using the same technique. They are usually done to correct a knock-kneed alignment.

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