A knee osteotomy is a joint-preserving realignment procedure to treat knee pain or instability. When conservative treatments for knee pain or instability stop offering sufficient relief, deciding on the next step can be challenging — especially for active adults who aren’t ready for a joint replacement. The Ohio State University Wexner Medical Center in Columbus, Ohio, is home to orthopedic knee surgery specialists who are experts at innovative knee-preservation techniques, such as osteotomy.
What is a knee osteotomy?
A knee osteotomy is a surgical procedure where part of a bone in your lower leg is cut to shift the positioning and alignment of your knee joint. This changes the point where you bear weight on your knee, relieving pain and instability caused by chronic arthritis or a cartilage, meniscus or ligament injury.
Osteotomies can be done on bones in other parts of your body, but the knee is one of the more common areas where osteotomies are performed.
Types of knee osteotomies
Where your bone is cut will depend on where your pain is, and the specific alignment of your bones. The three main types of knee osteotomies are:
- High tibial osteotomy (HTO) – Surgery is done on your shinbone (tibia), just below the kneecap.
- Distal femoral osteotomy (DFO) – Surgery is done on your thighbone (femur), just above the kneecap.
- Tibial tubercle osteotomy (TTO) – Surgery is done where the kneecap attaches to the shinbone, allowing us to move the kneecap.
Why is an osteotomy performed?
An osteotomy is performed to relieve knee pain or instability associated with chronic arthritis or cartilage, meniscus or ligament injuries. Osteotomies for these reasons shift the weight from the painful, injured part of the knee to the healthier part of the knee that doesn’t hurt. Sometimes an osteotomy may be performed to make the knee stable if you have torn your anterior cruciate ligament (ACL) multiple times.
Who is a candidate for an osteotomy?
To determine whether you might be a candidate for a knee osteotomy, you’ll be evaluated by one of our expert knee surgeons. You might be a candidate if you:
- Have arthritis but are younger and plan to stay active
- Want to delay joint replacement and preserve the knee as long as possible
- Need to treat bowlegs (knees bent outward) or knock knees (knees bent inward)
- Have torn your ACL multiple times in the same knee
Benefits of a knee osteotomy
An osteotomy is usually successful at relieving pain and instability due to arthritis. For many people, it can delay the need for a knee replacement by 10 to 15 years.
How is an osteotomy performed?
How an osteotomy is performed depends on several different factors, including the type of surgery, your condition and whether we’re repairing ligaments or other parts of your knee during the same procedure.
However, typically, the surgery will follow these steps:
- First, you’ll receive anesthetic to prevent you from feeling pain during surgery. This is either a general anesthetic to put you to sleep or a spinal anesthetic (an epidural, or nerve block) to numb you from the waist down. In the case of spinal anesthetic, you may also receive other sedation.
- Your surgeon will then make incisions in the skin to expose the bone, and the bone is surgically cut only partway through. What happens next depends on whether the surgeon is using a closing wedge method or an opening wedge method.
- In the closing wedge method, a small piece of bone is removed, and the gap is closed and held shut with a metal plate and screws.
- In the opening wedge method, the surgical cut is carefully opened and held open with a metal plate and screws. Sometimes, a bone graft is used to fill the gap of the opening wedge. A bone graft can come from your own body (usually your hip bone), from a donor, or from man-made materials.
What to expect with an osteotomy
Facing a surgery like a knee osteotomy can feel overwhelming, but knowing just what to expect can help calm some of those nerves. Our expert knee team will make sure you’re well prepared and will walk you through each step.
Preparing for an osteotomy
Before your surgery, you may have a physical exam and imaging, such as X-rays, done to prepare for the osteotomy. You’ll also be directed to stop certain medications in the weeks leading up to surgery. Avoiding smoking is also advised as smoking can interfere with bone healing.
Be sure to follow any instructions about when to stop eating and drinking before the surgery. This will keep you safe during surgery and allow the surgery to start on schedule.
During an osteotomy
A knee osteotomy typically lasts between one and two hours; however, it could be longer if we’re repairing other parts of the knee during the surgery.
After an osteotomy
You’ll wake up in a recovery room and may spend a night in the hospital following the procedure. During that time, you’ll receive medications to manage pain and prevent infection. Your knee will remain elevated and iced to reduce swelling. Most people are fitted for a brace to keep the knee from moving, so it can heal properly.
How long does it take to recover from an osteotomy?
Length of recovery can vary, but generally people are able to enjoy their favorite activities within three to six months following a knee osteotomy. You’ll need to be on crutches and avoid bearing weight on your knee for between four and six weeks after surgery. Your gradual recovery process will include physical therapy and follow-up appointments to ensure the knee is healing.
Some tips to help ease recovery from an osteotomy include:
- Take medications as directed to keep pain manageable.
- Keep incisions dry while bathing.
- Avoid bearing weight on leg until told to do so.
- Apply ice.
- Wear knee brace as directed.
- Participate in regular physical therapy and complete exercises at home.
- Ask for help from family or friends when needed.
- Be patient, as taking time to recover completely can produce better outcomes.
Risks of an osteotomy
A knee osteotomy is a relatively safe procedure, but as with any medical treatment, there can be risks or complications. Risks of an osteotomy include:
- Infection
- Blood clots
- Bone fracture
- Knee stiffness
- Failure to relieve the pain or instability
- Nerve damage or damage to blood vessels and tissue
Why choose Ohio State for an osteotomy?
The Ohio State Wexner Medical Center and its expert orthopedics team are at the forefront of innovative knee surgery and treatments. While few people may be candidates for immediate joint replacement, we know many others can benefit from the knee joint-preserving procedures that aren’t always available elsewhere.
Not only is Ohio State Sports Medicine at the leading edge of knee pain research and advancement, we’re also the choice of athletes all over central Ohio and the country. Our knee surgeons and specialists serve as team physicians for Ohio State Athletics as well as professional and Olympic athletes everywhere. We make this elite care available to you.