Suffering from knee arthritis usually means that you are in pain and cannot always do the things you want in life. You may choose to treat the condition with painkillers or if your pain is severe, you may choose to have your knee joints cut out and replaced with artificial ones.
Mr Chatoo can treat your arthritis by preserving your knees rather than replacing them. If you have early stage arthritis, you may benefit from an osteotomy. This is cutting edge surgery and we mean it is literally cutting the edge off your bones to straighten them, realigning your weight through your knees to relieve your symptoms.
Knee osteotomy is usually indicated in younger more active patients whose arthritis is at an early stage. However, with preoperative digital planning and modern surgical techniques increasing accuracy and safety it has been shown to have good results in older patients wishing to avoid a total knee replacement.
What are the advantages of an osteotomy over a knee replacement?
Osteotomy aims at relieving pain and preserving your own knee joint delaying the need for a knee joint replacement for some years. It can allow a younger patient to lead a more active lifestyle for many years. Unlike after a knee replacement (where there are limitations in what you are allowed to do) following recovery you will be permitted to return to your full activities even impact sports if you are able and wish to. Around 80% - 90% of patients feel a significant improvement in their knee following an osteotomy. In the future if your arthritis has progressed you can still have a knee replacement.
Many years ago before joint replacement, osteotomy was the standard technique for treating osteoarthritis of the knee. However, realigning the knee was carried out by “eyeballing” the correction and therefore results were mixed. Some patients knees were overcorrected resulting in arthritis developing on the normal side of the joint and others were under corrected resulting in persistent pain. Also with older surgical techniques and instruments the risk of nerve and blood vessel damage was higher.
When joint replacement came along and started yielding good results, osteotomy was abandoned except in very young patients with osteoarthritis.
With careful preoperative planning and modern surgical techniques the planned correction is now more reliably achieved and osteotomy has had a resurgence over the last ten to fifteen years. It is widely practiced in other parts of the world but is not widely available in the UK due to lack of surgical experience and old prejudices. Osteotomy has become a procedure that has a number of advantages over joint replacement and can be considered in a significant number of patients with painful knee osteoarthritis.
The results of knee replacement are not as good as hip replacement. We know from the National Joint Registry that up to 20% of patients who have had a knee replacement without a complication can be unhappy with their outcome. The knee joint is a much more complex structure than the hip and so a knee replacement does not recreate a normal joint. It is well known that younger patients do worse than older patients after total knee replacement surgery. Also once bone has been removed from the knee joint and replaced with metal and plastic you do burn your bridges and any further problems will need more surgery. Knee replacements do have a limited lifespan and revision surgery can be extremely demanding. Also complications such as infection or fracture within or around a knee replacement can be a devastating complication, particularly in the young patient, often requiring further major surgery.
This is an example of a closing wedge osteotomy of the tibia (shin bone) before and after operation
For more information or to book an appointment to see Mr Chatoo please contact his private medical PA, Annie Simpson, on 07876 870703.