Osteoarthritis of the knee
When osteoarthritis occurs in the knee, the articular cartilage becomes rough and thin and can wear down to expose the underlying bone. Articular cartilage is a layer of firm, slippery material that covers the ends of bones which make up joints. In the knee joint there is articular cartilage on the end of the femur (thigh bone), the top of the tibia (shin bone) and the back of the patella (knee cap). The bone at the edge of your joint can grow outwards forming bony spurs called osteophytes. The knee may swell and becomes gradually more painful over time.
If the knee joint is mal-aligned then abnormal forces cause excessive pressure on either the medial (inner) or the lateral (outer) aspect of the knee. Osteoarthritis in a mal-aligned knee can mean that while one side of the knee joint is damaged, the other side is relatively well preserved.
In your case, the medial aspect of your knee is damaged by osteoarthritis. You may be aware that your leg has become more bowed and this may impair your walking ability and cause pain even when at rest.
An osteotomy is a surgical operation whereby a bone is cut to alter its length or change its alignment. A high tibial osteotomy involves cutting into the tibia below the painful side of your knee and wedging open a large enough gap to re-align the lower leg. A metal plate is used to hold open the gap and is held in situ with screws. Over time your own bone will grow into the gap.
Often, a keyhole examination of the knee (arthroscopy) will precede the osteotomy to make a final assessment of the knee joint, under the same anaesthetic.
The main aim of a high tibial osteotomy is to shift your body weight off the damaged area of your knee to the lateral side where the cartilage is still healthy. This in turn is intended to relieve your knee pain and should improve your walking pattern and function.
Unfortunately a high tibial osteotomy will not return your knee to normal. It is generally considered a method of prolonging the time before a knee replacement is necessary, as the benefits typically fade after eight to ten years, but can last longer.
All operations involve an element of risk:
- Potential complications from a high tibial osteotomy include residual osteoarthritis symptoms (such as stiffness or swelling), tibial fracture, delayed or non-healing of the osteotomy or pain from the metal plate (which may need later removal).
- Uncommon problems include infection and blood clot (otherwise known as deep vein thrombosis or DVT);
- Rare but potentially serious problems include nerve or blood vessel injury;
- Minor complications relating to the anaesthetic such as sickness and nausea are relatively common. Heart, lung or nervous system problems are much
Please discuss these issues with the doctor if you would like further information
The intended benefits of high tibial osteotomy surgery are to:
- Correct poor alignment of the knee
- Prolong the life of the knee joint, delaying the need for Total Knee Replacement surgery. In some patients, knee replacement may be avoided
- Reduce pain
- Improve function
- Improve quality of life
Frequently Asked Questions
This is used to decrease the pain in the knee joint and the incision area immediately after your operation which can:
- Reduce the risk of feeling sick or vomiting
- Allow you to eat and drink earlier
- Enable you to get up and mobilise earlier
- Lessen the chance of an overnight stay in hospital
You will be given painkillers (either as tablets or injections) to help reduce the discomfort whilst you are in hospital. A one week prescription for continued pain medication will be given to you for your discharge home. Keep the pain under control by using the medication regularly at first. It is important to keep the pain to a minimum as this will enable you to move the knee more easily, recover muscle function in your thigh muscles, and begin the exercises you will be given by the physiotherapist.
f you do not have any circulatory disorders, you will benefit from applying ice regularly following surgery. This will help to minimise pain and swelling. Firstly wrap the knee with cling film when applying prior to your wound having healed. Then place a bag of frozen peas, ice cubes, or an ice pack in a damp tea towel. Elevate your affected leg and apply your ice pack for approximately 20 minutes. This should be done regularly throughout the day.
You will be provided with a pair of crutches for use when walking. Unless you have been instructed otherwise, due to more complex surgery (such as a cartilage repair in addition to your ACL repair) the crutches are used for comfort. You can gradually decrease their use as comfort allows. It is important that you take the weight through your leg in the correct manner i.e. putting the heel down first. Be guided by your physiotherapist who will inform you as to when you can discard them. The crutches can be returned to Wrightington physiotherapy department when you have finished using them. It is very important you follow the advice on how to use the crutches and avoid twisting or pivoting on your knee as this may damage your graft. It is also important that you are not on your feet for prolonged periods of time early on after the operation as this may increase your swelling.
Yes. It is important to start getting the knee moving but in a controlled manner. The Physiotherapist will show you the exercises you will need to start with. These will be progressed as you are physically able under the guidance of your physiotherapist. You will be referred for continued physiotherapy as an out-patient and it is essential that you are seen within one week of your operation.
When you are discharged from hospital you will have a compression bandage on your knee that should remain in place for 24-48 hours. After this time, remove the bandage and change the small plaster dressings underneath if they are blood stained. You must take extra care to ensure you have thoroughly washed your hands to prevent infection before you change the dressings.
It is important to keep your wound clean and dry until it is fully healed. Stitches, clips or steri-strips may need removing which is usually carried out between 10 and 14 days after your operation. The ward staff will inform you about how to get them removed. They may send a referral to your GP or you may be instructed to go to your GP to arrange this yourself. Alternatively, this may be done at your first clinic visit. The wound should remain covered with the dressings until the stitches, clips or steri-strips are removed.
You may shower before the removal of the stitches/clips/steri-strips – you will need to put several layers of cling film around your knee to keep the area dry. Pat the area when drying yourself and do not rub over the wound sites. Be guided by the clinician who
removes your stitches/clips/steri-strips as to when you can stop using cling film and leave the wound uncovered.
An appointment is usually arranged for 2-3 weeks after you are discharged from hospital to check your progress. Please discuss any queries or worries you may have when you are at the clinic. Appointments are made after this as necessary.
If you have not received an appointment it is essential you phone the outpatient department.
Your physiotherapy appointments should begin within one week of your operation and these will continue for several months until you are able to return to your normal pre-injury activities.
To protect your new graft you will need to avoid putting too much stress through it. You should not perform any twisting, turning or pivoting manoeuvres on your affected leg. You should also avoid straightening the leg out when you are in a sitting position i.e. a leg extension exercise.
You should avoid standing for prolonged periods of time as this will increase the swelling in your knee. If your knee is swollen you will need to elevate your leg and use ice as instructed.
It is important to avoid walking with a limp – use crutches if needed to allow you to put the weight through your leg in the correct manner i.e. walking with the heel going down first, and also not walking on a bent knee.
This can be divided into 3 stages.
- Sling on, no movement of shoulder except for exercises
You will basically be one handed immediately after the operation. This will affect your ability to do everyday activities, especially if your dominant hand is the side of the operation.
Activities that are affected include dressing, shopping, eating, preparing meals and looking after small children. You will probably need someone else to help you. You may also find it easier to wear loose shirts and tops with front openings.
- Regaining everyday movements
When advised, you can gradually wean off using the sling and you will start outpatient physiotherapy. You will be encouraged to use your arm in front of you, but do not take it out to the side and twist it backwards. Exercises will help you regain muscle strength and control in your shoulder as the movement returns. The arm can now be used for daily activities.
Gradually, you can return to light tasks with your arm away from your body. It may take 6-8 weeks after your operation before you can use your arm above your shoulder height.
- Regaining strength with movement
Under guidance, you will be able to increase your activities, using your arm away from your body and for heavier tasks. You can start doing more vigorous activities, but contact sports are restricted for at least 4-6 months. This is dependent on the procedure and should be discussed with your surgical team. You should regain the movement and strength in your shoulder within 6-8 months. Research has shown that after 2-5 years about 90 out of 100 people have a stable shoulder with few limitations. Vigorous sports or those involving overhead throwing may require adaptation for some people, although many return to their previous levels of activity.
You may drive when you are comfortable and safe to do so. You must have stopped using crutches, be able to sit comfortably and have enough power and bend in your knee to perform an emergency stop. The law states that you should be in complete control of your car at all times. It is your responsibility to ensure this and to inform your insurance company about your surgery. Please ask your physiotherapist for advice.
When you return to work depends very much on the demands of your job and it is difficult to generalise. You need to feel that you can cope with the tasks involved in performing all duties of your job including any travelling required. As a general rule it is recommended that if you are in a sedentary job you will require approximately 2-3 weeks off work. For a heavy manual job or one which involves twisting, turning and running you may require up to 12-16 weeks. Discuss this with your surgeon and physiotherapist before you contemplate a return to work and you may also wish to consider approaching your employer regarding a phased return.
It is recommended that you do not fly for six weeks after the surgery.
During your first visit after surgery your physiotherapist will decide how often they would like to see you depending on your progress. Initially you may need regular appointments to help and support you through the early stages of rehabilitation. You will be given exercises to perform at home and in the gym and you may progress to a gym-based class at the physiotherapy department.
It is extremely important that you continue to work on the exercise programme you are given and follow your physiotherapist’s instructions carefully.
Your return to leisure activities will be guided by your physiotherapist and will depend on how you are progressing and whether you are reaching certain goals. Your therapist will advise you when you are physically capable of dealing with different activities and will ensure you progress to a level where it is safe for you to return to sport.
The earliest return to sport is 6 months after your operation but this will vary depending on your progress. It is extremely important that you take guidance on this by your physiotherapist, as if you return too early you may not achieve a good outcome from your surgery, and you have a greater chance of your reconstruction failing.