Tibial Osteotomy

Osteotomy of the knee, or tibial osteotomy, is a surgery that involves making a cut in either the tibia (shinbone) or femur (thighbone) to relieve pressure. There are different kinds of tibial osteotomy procedures. Read on to learn more about each of them and how they work.

What Is A Tibial Osteotomy?

The literal translation of osteotomy is "cutting of the bone." A knee osteotomy, also known as a tibial osteotomy, is usually performed to correct damage caused by osteoarthritis or a deformity, and it has three goals: to transfer weight from the arthritic part of the knee to a healthier area, correct poor knee alignment, and prolong the lifespan of the knee joint.

At Resurgens Orthopaedics, we offer a few different types of tibial osteotomy procedures, which each serve different situations. These include:

  • High Tibial Osteotomy corrects bowleggedness by removing a wedge of bone from the tibia and sometimes the fibula. A metal plate is inserted to help the tibia heal in the correct position.
  • Tibial Osteotomy with Closed Wedge involves splitting the tibia in two places and removing a wedge of bone. It uses a metal plate to hold the cut pieces together.
  • Tibial Osteotomy with Open Wedge involves creating a wedge-shaped opening by cutting the tibia at an angle. A metal plate and surgical screws hold open the wedge while it heals.
  • Tibial Tubercle Osteotomy corrects patellar tracking disorder by realigning the tibial tubercle with metal plates, wires, and screws.

Why Is A Tibial Osteotomy Performed?

A tibial osteotomy is often performed when a patient has early stage osteoarthritis that has damaged one side of the knee joint, and other treatments are no longer offering the necessary relief. This procedure shifts the weight off of the damaged side of the joint, which helps relieve pain and significantly improve your knee's function.

How To Prepare For A Tibial Osteotomy

Before a tibial osteotomy, it's important to tell your doctor about any medicine, drugs, supplements, herbs, or over-the-counter medications you're taking. Two weeks before your surgery, you may be asked to stop taking any medication that makes blooclotting harder. Consult with your doctor about which of your regular medications you can take on the days ahead, or the day of, your surgery. It's important to let your doctor know if your alcohol intake is more than 1-2 drinks a day or if you smoke regularly. Smoking can slow down bone and wound healing, so it's important to avoid smoking in the weeks ahead and after your surgery.

On the day of your surgery, you will be asked not to drink or eat anything for 6 to 12 hours before the procedure. Take the medication your provider instructs you to take with a small sip of water. Make sure you arrive at the hospital on time. After surgery, the amount of time you spend in the hospital varies and can depend on how quickly you recover.

What Happens During A Tibial Osteotomy?

Your tibia is the large bone of your lower leg. During a tibial osteotomy, your tibia is adjusted to better align your knee and your leg, which can help delay or entirely avoid a knee replacement. Before the surgery, you'll be given medicine to make you feel numb and relaxed, and you may also be put to sleep. Then, an incision is made below your knee.

In order to align the joint, there are a few different methods we may use. One involves removing a wedge of bone from your tibia. Another method corrects the alignment by making a cut and spreading your bone apart. The type of osteotomy procedure you undergo depends on what adjustments need to be made to align your joint.

After the procedure, we will close and bandage your skin. We'll keep a close eye on you for a brief time as you wake up. Then, your surgeon will give you instructions to ensure a safe and smooth recovery.

Tibial Osteotomy with Closed Wedge

With this surgery, we treat a knee that has early-stage arthritis on only one side, and we shift your body's weight to the healthier side of your knee. This relieves pain and improves your knee's function. After giving you anesthesia to put you to sleep, we make an incision to reach the tibia. We then make two cuts in this bone below the healthy side of the knee joint, freeing a wedge of bone to create a gap.

Then, we remove the wedge of bone and bring the upper and lower parts of the tibia together to close the gap. This changes how your lower leg lines up with your knee and shifts your body's weight from the bad side of your knee to the healthy side. Finally, we secure the upper and lower parts of the tibia. Over time, the cut in the bone will heal.

Tibial Osteotomy with Open Wedge

Similar to a tibial osteotomy with closed wedge, this surgery treats a knee that has early-stage arthritis on only one side, relieving pain and improving your knee's function. After giving you anesthesia, we make an incision to reach the tibia and make a cut in this bone below the damaged side of the knee joint. Then, we spread apart the tibia at the cut which creates a wedge-shaped space in the bone and changes how your lower leg lines up with your knee. This shifts your body's weight from the bad side of your knee to the healthy side. We fill the open space with a bone graft and secure the upper and lower parts of the tibia. Over time, new bone will grow between them, fusing them together.

Tibial Tubercle Osteotomy

Tibial tubercle osteotomy is a surgery that treats patellar tracking disorder. It corrects the position of your patella; the bone we call the "kneecap." To begin, you're put to sleep or given medicine to make you feel relaxed and numb, then we will make an incision to reach your knee joint.

The tibial tubercle is the bony bump you feel at the top of your shin, on the front of your tibia. One end of the patellar tendon is attached to the tibial tubercle, and the other end is attached to the base of your kneecap. In order to realign your kneecap, we make a cut in the tibia to free the tibial tubercle. We shift the tibial tubercle and the attached tendon to correct the kneecap's alignment

Are There Risks Associated With Tibial Osteotomy?

Just like with any surgical procedure, there are risks involved with a knee osteotomy. Although the risks are low, the most common complications include:

  • Infection in the knee joint
  • Blood clots
  • Knee stiffness or a knee joint that is not well-aligned
  • Injuries to a blood vessel or nerve
  • Failure of the osteotomy to heal, which may require more surgery or treatment

Your surgeon will discuss each of the risks with you and will take specific measures to help avoid potential complications.

Post Tibial Osteotomy Treatment & Recovery

After a tibial osteotomy procedure, most patients stay in the hospital for 1-2 days. A physiotherapist will visit you to assist you with gentle exercises and stretches so you can start to move around on your own. You will likely wear a knee brace for up to six weeks after surgery to protect the knee joint as you recover, and after 10 to 14 days, you will need to return to the hospital to have your stitches removed. Keep in mind, you won't be able to drive and you will need to use crutches for several weeks after surgery.

Continuous physical therapy throughout your recovery will ensure you improve your range of movement, are able to bear weight on your operated knee, and increase your strength and endurance. About 6 weeks after your surgery you will have a follow-up appointment with your consultant, and they will take an x-ray to confirm if the bones are growing properly. Full recovery can take up to 12 months.