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Archive for the ‘Osteotomy’ Category

High Tibial Osteotomy

High Tibial Osteotomy

A high tibial osteotomy (HTO) is a surgical procedure used to treat knee osteoarthritis.  During the surgery a wedge-shaped bone is removed from the lower-leg.  This changes the angle of the knee joint and relieves pain.

You will be treated with intravenous medications immediately following surgery.  This will help reduce the chance of getting an infection from the hospital, help reduce the risk of blood clots, and help with the pain.  Expect to be in the hospital up to one week on the high side.

Once you get home crutches, a cane, or a walker will be required for about one month.  You will be able to put some weight on your leg, but how much and when will be up to your doctor.  Physical therapy will also be prescribed and required.

Most HTO’s are successful.  Make sure to ask your doctor for a detailed recovery plan so you will know exactly how long you will be off your feet.    Patients who have a high tibial osteotomy will experience swelling for 3 to six months.



Peroneal Nerve

Peroneal Nerve

There are various complications that can arise from high tibial osteotomies (HTO).  Neurologic injuries such as damage to the peroneal nerve are one of those complications.  HTO’s are often performed to relieve the pain associated with knee osteoarthritis.

The peroneal nerve lies between the biceps femoris tendon and the outside top portion of the calf muscle, and winds around the top of the fibula bone.  The peroneal nerve branches out to various other nerves in the lower leg.  Nerves are like cables that provide pathways for the electrochecmical impulses that drive the central nervous system.

Damage to the peroneal nerve can result in drop foot, making the foot drag during walking.  Also feeling can be lost in the top of the foot and front of the lower leg.



Popliteal Artery

Popliteal Artery

A common surgery to treat osteoarthritis of the knee is a high tibial osteotomy.  Complications during the surgery can include neurologic injuries.  One such injury is damage to the popliteal artery.

The popliteal artery is an extension of the femoral artery, located behind the knee.  It supplies blood to the knee joint and muscles in the thigh and calf. Arteries are blood vessels that bring oxygen rich blood from the heart to various tissues in the body.

Damage to the popliteal artery can cause a partial or complete blockage of blood flow to the foot and lower leg.  This can cause pain, difficulty walking, or amputation.



Non Union

Non Union

High Tibial Osteotomies (HTOs) are a surgical procedure used to treat knee osteoarthritis.  There are complications with HTO’s.  Non-unions are one of those complications.

A non-union is when a broken bone fails to heal.  Non unions occur when the broken bone lacks blood flow or the fracture is unstable.  Tobacco use, old age, diabetes, and infections can make this condition worse.

Broken bones also need nutrition to heal.  Calcium, Vitamin C, Vitamin D, and protein are all necessary for bones to heal properly.

Bone grafts or bone growth stimulators are used as treatment options for non-union fractures.



HIgh Tibial Osteotomy

HIgh Tibial Osteotomy

High Tibial Osteotomies (HTO) are surgical procedures used to treat unicompartmental osteoarthritis of the knee.

Osteonecrosis is one of those complications.  It is “bone death” caused by poor blood supply to the affected area.  Though osteonecrosis is mst common in the hip and shoulder, in high tibial osteotomies it usually presents in the bone fragment above the surgical site.

There aren’t any symptoms in the early stages of this condition.  But as it gets worse you may feel pain in the joint that increases over time, pain at rest, limited range of motion, and limping.

Bone grafts and joint replacement are the usual treatment options for osteonecrosis.



Knee Surgery

Knee Surgery

Deciding to have surgery is never easy.  You need to consult with your surgeon and discuss your medical history.

High tibial osteotomies are most successful in patients who understand exactly what they are getting into.  Patients should not be overweight, they should be active, and have a high tolerance for pain.  Also patients need to be able to take several weeks if not months off of work.

This surgery is not a treatment option for everyone who suffers from osteoarthritis of the knee.



High Tibial Osteotomy

High Tibial Osteotomy

There are two different types of high tibial osteotomy surgeries to treat knee osteoarthritis.

A “closing wedge” osteotomy cuts out a wedge of bone to change the angle of the knee joint.

An “opening wedge” cuts the bone and fills the gap with a graft to change the angle of the knee.

Either surgical procedure is significant because the bones supporting your body weight are fractured, and then fixed.  You will be off your feet for up to 6 weeks and a return to full activity can take as long as six months.



Osteoarthritis of the Knee

Osteoarthritis of the Knee

Unicompartmental Osteoarthritis is the primary indication for a high tibial osteotomy.  Unicompartmental means that only one side of the knee is affected by the arthritis.

Once the cartilage between the femur and tibial plateau starts eroding the angle at the knee joint begins changing.  If the inside of the knee wears away the result is a “bow-legged” deformity.  If the outside of the knee wears away then the angle makes the legs appear “knock-kneed”.

The goal of a high tibial osteotomy is to realign the bones and restore a more normal angulation.



High Tibial Osteotomy

High Tibial Osteotomy

A high tibial osteotomy (HTO) is a surgical procedure often associated with osteoarthritis of the knee.

“Osteo” means bone.  “Otomy” means to cut.  So an osteotomy is a cutting of the bone.  Osteotomies are usually used to correct angulations of bones.  In the case of unicompartmental osteoarthritis, the surgery requires that a wedge of bone is removed from beneath the affected compartment.



Osteotomy

Osteotomy

This post is part of a series of blog posts about the American Academy of Orthopedic Surgeon’s Full Treatment Guideline for Knee Osteoarthritis.

Recommendation 21 – Realignment osteotomy is an option in active patients with unicompartmental OA of the knee with malalignment.

The research team found conclusive evidence that realignment osteotomies had benefits that lasted up to two years after surgery in patients that had knee OA and malalignment issues.