High Tibial Ostyeotomy : Procedure for young arthrtic patients:
We have started seeing young patients with severe pain in knee joints due to early onset of arthritis. It has become a routine to see patients in the age group of 38 to 48 with severe knee arthritis. A total knee replacement is not possible in tis group. Most of theese young arthritic patients have bowed legs. 60% of our body weight passes through the innner compartment (medial) and hence many of us start developing bow legs – the inner side gets worn out earlier than the outer half. Here is an X-ray showing exactly what I mean.
There is a solution avavilable for such patients. We correct this bow leg deformity by cutting a piece of bone and opening up a wedge. See figure below
So who can qualify for this surgery?
Patients have to fulfill certain criteria. Patients above 80 kg generally do not do well with this procedure. They should also have bow legs with a deformity not exceeding 25 degrees. They should have a knee bend greater than 90 degrees (a normal knee bends 155 degrees …heel touching the back of the thigh). Patients should be below the age of 60 years. Patients should have arthritis only of the inner side of his knee.
I do examination first and then standing X-rays. Those who fulfill all criteria then are selected to undergo this procedure.
This surgery takes an hour to perform. The wedge of the bone cut is filled either by patients own bone taken from the hip or artificial bone readily available. The bone is supported by a plate and few screws. There is no plaster after the surgery. The patient can walk around with the help of crutches on the 2nd day. Usually patient s goes home on the 3rd day. Patients are not allowed to touch their feet on the ground for 3 months. They can however bend their knee fully. This how the x-ray looks after the surgery.
I recommend the plate to be removed after 2 years. Patients become pain free gradually and also need to lose weight if they are overweight. It takes generally one year to become totally pain free. It is worthwhile to remember that this procedure does not stop the age related degeneration and the patient has to take care even after the surgery i.e. to maintain his/her weight near the recommended weight and do knee exercise as shown.
Fortunately there are no major risk factors involved in the surgery.
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