Corrective osteotomy is a surgical procedure commonly used to treat knee deformities such as bowlegs (varus deformity) and knock knees (valgus deformity), especially in young patients. The aim of this surgery is to realign the bones of the knee to relieve pain, improve joint function, and delay the need for total knee replacement. In this article, we explore the effectiveness of osteotomy as a long-term solution for knee deformities and osteoarthritis, based on a study with a follow-up of up to 40 years.
Overview of Osteotomy for Knee Deformities
Osteotomy around the knee involves cutting and realigning the bones to correct deformities. The procedure is commonly performed on young individuals with deformities such as bowlegs or knock knees, and can also be used for more complex conditions like osteoarthritis or malunited fractures. The primary goal of osteotomy is to redistribute the weight and stress on the knee joint, which often reduces pain and improves function.
The types of osteotomy performed include:
- Supracondylar femoral osteotomy (SCFO): Corrects varus deformities by removing a wedge of bone from the femur.
- High tibial osteotomy (HTO): Performed above or below the tibial tuberosity to correct varus or valgus deformities. This is the most common form of osteotomy for patients with osteoarthritis in the knee.
- Osteotomy below tibial tuberosity (LTO): Used primarily in children to avoid damaging the growth zone of the tibia.
These techniques aim to improve the mechanical alignment of the knee and reduce the stress on the affected compartments, especially the medial compartment in cases of osteoarthritis.
Long-Term Outcomes of Corrective Osteotomy
The long-term results of knee osteotomy have been extensively studied, particularly for patients under 40 years of age. A study that followed 57 knees over a period of 30 to 38 years found that corrective osteotomy provided lasting relief for most patients. The study participants, who underwent osteotomy for deformities such as bowlegs, knock knees, and malunited fractures, reported good outcomes with minimal symptoms at follow-up.
- Correction of Deformities: At the final follow-up, the deformities were successfully corrected in all but a few knees, which showed signs of osteoarthritis or required total knee arthroplasty.
- Pain Relief: Most patients experienced significant pain relief, particularly after the initial post-surgical recovery phase. However, a small percentage developed osteoarthritis in the contralateral knee over time.
- Functionality: The range of motion and functionality of the knee improved in nearly all patients, with some patients reporting a return to active lifestyles, including sports.
Patient Selection and Surgical Considerations
The success of osteotomy largely depends on proper patient selection. Ideal candidates for corrective osteotomy are younger patients who are still active and wish to preserve their knee joints. The procedure is especially beneficial for individuals with knee deformities resulting from congenital conditions, trauma, or previous surgical interventions.
Factors to consider in surgical planning include:
- Age and activity level: Osteotomy is typically recommended for patients under 60 years old who wish to maintain knee function for as long as possible before resorting to joint replacement.
- Severity of deformity: Correcting severe deformities, especially varus deformities with significant cartilage damage, may require more complex techniques and longer recovery times.
- Type of deformity: Varus and valgus deformities are the most common, but osteotomy can also be used for rotational deformities or deformities caused by conditions such as rickets, Blount’s disease, or achondroplasia.
Outcomes Based on Type of Osteotomy
- Supracondylar femoral osteotomy (SCFO): Effective in correcting varus deformities, this method provides stable results with improved limb alignment. However, it may be less suitable for patients with severe osteoarthritis or those with malunited fractures.
- High tibial osteotomy (HTO): High tibial osteotomy has been widely used to treat knee osteoarthritis in younger patients. Studies have shown that it significantly improves knee function and pain relief, especially when performed before the development of severe joint degeneration.
- Lateral tibial osteotomy (LTO): A common procedure for children with deformities, LTO offers the advantage of preserving the growth plates while correcting angular deformities.
Complications and Risks
While corrective osteotomy generally offers good results, like any surgery, it carries risks. Some of the complications associated with knee osteotomy include:
- Infection: As with any surgical procedure, infection is a risk. Proper post-operative care and adherence to hygiene protocols can minimize this risk.
- Non-union: In some cases, the bone may not heal properly, which could require a second surgery.
- Osteoarthritis progression: Although the procedure can improve joint alignment and reduce pain, osteoarthritis may continue to progress in the long term, especially if the cartilage has been severely damaged before surgery.
- Joint instability: Incorrect alignment or overcorrection of the knee joint can lead to instability or increased stress on other parts of the knee.
Conclusion
Corrective osteotomy remains a highly effective procedure for treating knee deformities in young, active patients, especially those seeking to avoid knee replacement. With proper patient selection and surgical technique, osteotomy can provide long-term relief from pain, improved knee function, and a delay in the need for joint replacement surgery. However, patients should be informed about the potential risks and complications, including the possibility of osteoarthritis development in other areas of the knee over time. As surgical techniques continue to improve, the outcomes of osteotomy are expected to become even more favorable for patients requiring knee preservation.