Johns Hopkins Health Alert
Not Ready for Knee Replacement? Osteotomy May Buy You Time
As osteoarthritis (OA) of the knee progresses, pain medication and heat and ice packs may no longer provide relief. But what if you're not ready for a knee replacement? A less intense procedure called osteotomy may buy you time.
Osteoarthritis often damages the cartilage more on one side of the knee than on the other. That asymmetry causes the leg bones to become misaligned, which can put even more stress on the already damaged joint.
Osteotomy is a surgical procedure that cuts away bone to shift a person's body weight from the damaged area of the knee toward the healthy side. The procedure relieves pain and allows the knee to function more normally. As a result, many patients may be able to delay knee replacement surgery up to 10 years.
How osteotomy is done. First, the surgeon makes a 4- to 5-inch incision from just below the kneecap to below the top of the shinbone (tibia). Then, using an oscillating saw, the surgeon removes a wedge of bone from the healthy shinbone. If the cartilage damage is on the inner side of the knee, bone is removed from the outer part of the shinbone; for damage to the outer side of the knee, bone is removed from the inner part of the shinbone. The bone is taken from an area below the healthy cartilage. This removal allows the knee joint to open more freely and redistributes weight across the joint. Osteotomy takes about 60 to 90 minutes to complete. The realigned joint is held in place with staples or internal plates, or it may be immobilized with a cast.
Recovery from osteotomy. Recovery from osteotomy takes time and work. Rehabilitation begins almost immediately after surgery with gentle exercises to flex and stretch the knee and restore range of motion. You will be fitted with a knee brace (unless your leg is put in a cast) and will be on crutches for at least six weeks. Ideally, the brace may be removed within three to six months.
Physical therapy with a rehabilitation specialist usually begins at about six to eight weeks after the bone has had a chance to heal. You will learn stretching exercises at first and then move on to muscle strengthening and light aerobic activities. Regular exercise is also essential after physical therapy ends. Remaining physically active keeps the supporting muscles strong, helps impede further arthritic damage to the knee and prevents weight gain (which contributes to osteoarthritis). However, you should avoid running or other high-impact activities that could twist the knee.
Posted in Arthritis on July 11, 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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