What is a Tibial Osteotomy?
During a tibial osteotomy, the surgeon removes a wedge-shaped portion of the shin bone (tibia) to help compensate for a deformity in the knee joint. This deformity can cause the knee’s protective cartilage to wear on one side more than the other. This usually happens on the inside (medial side) of the knee.
Removing a piece of the bone under the knee changes the alignment of the shin and knee and redistributes the weight of the body on the knee. Changing the alignment can transfer the stress to a less worn area of the knee, helping to relieve pain.
What are the Benefits?
Tibial osteotomies treat a varus, or bowlegged, deformity at the knee. This deformity may result from past trauma or surgery, congenital deformity and/or the progression of a degenerative disease, such as osteoarthritis. Candidates for tibial osteotomies are in pain and may eventually require a knee replacement.
A tibial osteotomy could help delay a knee replacement for as many as 10 years. This makes the tibial osteotomy a viable option for younger patients who are not the best candidates for knee replacement since they will probably outlive the implant.
How is a Tibial Osteotomy Performed?
A tibial osteotomy usually involves cutting a wedge-shaped portion of bone from the tibia to correct the alignment of the knee. The surgeon will make a small incision on the front of the knee and/or another one on the side of the knee. The shinbone is exposed and a wedge-shaped piece of the bone is removed just below the knee. The leg is moved in a way that allows the gap in the bone to be closed in a hinge-like manner. The edges of the cut bone are then stapled or held together with plates and screws. The osteotomy site should heal just like a fracture.
Is There a Risk of Complications?
All surgeries have a risk of complications. Some of the major complications with tibial osteotomy include damage to the nerves or arteries of the leg, blood clots or even problems with the cut bones healing together. As with any surgery, patients should be aware of signs of infection, bleeding or abnormal swelling in the first few weeks after surgery. Patients should inform their doctor if any of these symptoms occur.
Additionally, some surgeons believe that the because of changes made to the bone during tibial osteotomy, it may make a total knee replacement more difficult down the road.
How Long is the Recovery?
Because the tibial osteotomy involves cutting the bone and having it mend back together, a significant postoperative course of therapy needs to be followed. Hospitalization can last from three to six days. Once out of the hospital, the knee will need to be immobilized with a cast or brace for at least six weeks. Crutches should be used during that time. Knee swelling can last for three to six months. Typically patients could miss three to six months of work, but that depends on the doctor’s recommendations and each individual case.
The road back to full weight bearing will differ with each patient’s progress and situation. Normally, weight-bearing activities can begin at six weeks after surgery and gradually increase up to 10 weeks post surgery. After 12 – 14 weeks the patient will be able to resume some higher impact activities. A physical therapist usually helps the patient through the rehabilitation process.