There is plenty of information around on total knee replacement but relatively little on the common surgical precursor, the high tibial osteotomy.
Osteotomy is a medical term meaning 'to cut a bone'. High tibial refers to its location, just below the knee joint. So this operation's name pretty well describes what happens. But why cut the bone?
Osteotomies are done to change the alignment of a bone and hence the angle of a joint. If your knee is bow-legged, you are taking all of your weight through the inside half of your knee. This leads to much greater rates of wear and much more pain. A high tibial osteotomy aims to straighten out your leg to evenly share the load between the inside and outside of your knee.
The are two main types of osteotomy for knee osteoarthritis. Opening wedge and closing wedge.
In an opening wedge, a cut is made in the tibia and the two sides are separated. The wedge shaped space is filled with a bone graft.
In a closing wedge, two cuts are made and a wedge shaped piece of bone is removed. The two edges are then brought together creating the desired change angle.
Both types of operation then require the bone to be fixed, usually with a plate and screws.
A high tibial osteotomy does not make the joint unworn so is looking to decrease pain rather than completely relieve it. The operation is seen as a way of delaying a total knee replacement in those considered too young. It is not suitable for everyone so individual cases need to be discussed with your surgeon.
Osteotomy is a medical term meaning 'to cut a bone'. High tibial refers to its location, just below the knee joint. So this operation's name pretty well describes what happens. But why cut the bone?
Osteotomies are done to change the alignment of a bone and hence the angle of a joint. If your knee is bow-legged, you are taking all of your weight through the inside half of your knee. This leads to much greater rates of wear and much more pain. A high tibial osteotomy aims to straighten out your leg to evenly share the load between the inside and outside of your knee.
The are two main types of osteotomy for knee osteoarthritis. Opening wedge and closing wedge.
In an opening wedge, a cut is made in the tibia and the two sides are separated. The wedge shaped space is filled with a bone graft.
In a closing wedge, two cuts are made and a wedge shaped piece of bone is removed. The two edges are then brought together creating the desired change angle.
Both types of operation then require the bone to be fixed, usually with a plate and screws.
A high tibial osteotomy does not make the joint unworn so is looking to decrease pain rather than completely relieve it. The operation is seen as a way of delaying a total knee replacement in those considered too young. It is not suitable for everyone so individual cases need to be discussed with your surgeon.
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had one done hurts like hell
ReplyDeleteme too, had one an it sure does hurt an suck. next step knee replacement, if i don't treat it with care. it's not my wife that had it...
ReplyDeletemakes an acl reconstruction seem getting a deep tissue massage.....hurts like hell
ReplyDeleteI was told 2 months on crutches, 4 months of re-hab, longer to get back to "normal". They made it "same day surgery", sent me home with a pain ball which lasts 48 hours. When that emptied, I went into shock due to the extreme pain and nature of what had been done. Was taken to the hospital by ambulance for a sonar-gram and pain management. Told the next day by my surgeon, you need to get out of here asap as it is the best place to get mercer. 10 weeks of zero weight bearing, 7 months so far and still on crutches. Horrible experience and I wonder if I will ever get to where I was. Worse off now that before surgery. It been a really bad experience and God only knows where this will lead me
ReplyDeleteHi Kevin,
ReplyDeleteIn my experience, it is extremely rare for patients to be given sufficient information about the recovery period following HTO. I tell people it will be a year before they are back to "normal" and ask them to consider the serious impact the surgery will have on their life. Work and family commitments are severely affected.
The average knee replacement patient will be walking with a cane at 6 weeks. For a HTO you will still be non weight-bearing on crutches at this stage.
The HTO is an effective operation in the right person but even the perfect patient will be disappointed if they go into the procedure unaware of the arduous recovery.
Same day surgery for a HTO is rather optimistic as the primary reason for delayed discharge in my experience is poor pain control.
Re-covering from HTO perform in the UK, after 7 weeks now walking without crutches and back to work (on light duties) full weight bearing due to a large T shaped plate controlling the osteotomy.
ReplyDeletePain was well controlled after the operation, will be having the Left knee done in December.
So far very happey whith the operation as the original knee pain has gone
Glad to hear it Steve, sounds like you had a good run.
ReplyDeleteThe type of internal fixation used can have a say in the speed of recovery. A Closing wedge osteotomy fixed with a decent sized plate will permit weight bearing relatively early when compared to other versions of the procedure. Sounds like this is what you had done.
Good luck with the left, hope all goes just as well.
It was a open wedge with about 8 deg of correction, its true that the quality of the surgeon is paramount my surgeon gave me some statistics of his work before we agreed on the procedure.
ReplyDeleteHe had performed 110 HTO out of which one had problems with the bone damage, one infection and 10% not completely satisfied with the end result.
I think the outlook and exceptions of the individual will also affect the outcome of the HTO.
All the best Steve
omg. I am scheduled for an HTO on Nov 17th. All i was told is that i wouldn't be able to drive for 6 weeks. i see now that driving will be the least of my problems!!!! Now having serious second thoughts.....
ReplyDeleteI am due to have a closed wedge HTO in 5 days. My surgeon says I won't be in a cast & I will be putting weight on it as soon as I can. I have high confidence in his skills. I am a little worried about pain control. They are keeping me for 1 night for that reason. I was told 3-4 months total recovery, is this right? I know there is a huge difference between opened & closed but just wanted someone else's opinion.
ReplyDeleteCasts are rare as complete immobilization of the knee quickly leads to stiffness. Common post-operative protocols use a Range of Motion knee brace to protect the knee from sideways forces while still allowing protected movement.
ReplyDeleteEarly protected weight bearing sounds like a closing wedge. Hopefully in 3 - 4 months time you will be walking around the house independently and starting to manage longer periods on your knee.