Realignment Osteotomy
This is a surgical procedure designed to realign bones around a joint to relieve pain and improve function, often used for patients with early-stage arthritis or deformities in the knee. This procedure is particularly beneficial for individuals with joint misalignment, where the weight-bearing surface of the joint has shifted, causing abnormal stress and pain. Jonathan utilises his expertise in this complex surgery to carefully cut and reposition the bones to restore proper alignment, thus redistributing stress across the joint and reducing pain. By performing periarticular osteotomy, Jonathan can help patients delay the need for joint replacement. His approach is highly personalised, using specialised three dimensional planning based off a CT scan and 3D printed instruments taking into account each patient’s unique anatomy. With his deep understanding of joint mechanics and surgical precision, Jonathan aims to optimise the outcomes of periarticular osteotomy, allowing patients to regain mobility and improve their quality of life.
The osteotomy may be performed either on the femur, the tibia or both depending on the patient’s individual anatomy. Personalised three dimensional planning takes place prior to any surgery in order to correct alignment. This is done by obtaining a CT scan of the lower limb and analysing it carefully for where there is any deformity. Once this has been done a personalised plan is created and special instruments are 3D printed in order to carry out the surgical correction. In general, if the leg is bowed to begin with, usually the osteotomy is performed on the tibia. If the leg is knock-kneed, then the osteotomy is usually performed on the femur. Excessive posterior slope of the tibial plateau may also be corrected in certain situations which may contribute to ACL graft failure.
The former is the more common scenario, and usually the procedure involves realigning the leg by creating a cut in the bone and opening up a wedge shaped gap in the tibia. This is often referred to an opening wedge high tibial osteotomy (OW HTO). Alternatively, the other option for treating the same problem is to remove a small wedge of bone from the cut tibia. This is called a closing wedge high tibial osteotomy (CW HTO). Occasionally it is necessary to perform a double level osteotomy on the femur and tibia. The osteotomy is held stable with a plate and screw type construct.
The proximal tibial slope has been more recently analysed in the setting of ACL graft rupture. When the tibial slope is excessive, reducing the slope in conjunction with revision ACL reconstruction aims to minimise the risk of any further ACL graft failure. The osteotomy involves removing a wedge of bone from the front of the tibia in a closing wedge technique. The operation can be done at the same time as ACL reconstruction revision or in a staged reconstruction scenario when the pre-existing bone tunnels need bone grafting.
The procedure is usually performed under a general anaesthetic, and the inpatient stay can be up to two to three nights. You may be partial weight bearing with crutches for a period of 6 weeks while the bone heals.