A tibial osteotomy is a surgical procedure where the tibia is cut to shorten, lengthen or change its alignment.
It is a useful operation used to relieve pain associated with osteoarthritis of the knee particularly where a patient has wear and tear in one side of the knee (typically the inner or medial side).
The goal is to shift the patient's body weight off the damaged area to the other side of the knee, where the cartilage is still healthy. This is achieved by removing a wedge in the top of the tibia from underneath the healthy side of the knee. This changes the alignment of the knee and unloads the damaged/worn section of the knee and allows for the healthier compartment to take the load.
The idea behind this is: osteoarthritis is due to or can result in malalignment of the knee. If the medial side is affected, this can result in varus malalignment or bowed knees. By removing a wedge of bone from the top of the tibia the normal alignment can be restored, which unloads the damaged surface from the extra load. Once the correct alignment has been achieved the osteotomy is stabilised with a plate so it will heal in the correct position.
Tibial osteotomy can be an alternative to knee replacement surgery (knee arthroplasty) particularly for the younger osteoarthritic patient who wants to continue an active lifestyle. There are no activity restrictions following an osteotomy, which allows patients to continue with high impact activities that aren’t recommended after joint replacement surgery.
Knee replacement surgery, no matter how well performed, is not designed for the rigors of a manual working life, or for a young active sporting lifestyle. Osteotomy can be used as an intermediate procedure before total knee replacement is necessary and to delay the need for the procedure. But it can also be a definitive operation for osteoarthritis in some cases.
After a tibial osteotomy a patient can expect significant relief from pain and disability. However, because the arthritis is not “removed” as such, osteotomy doesn’t always provide 100 per cent relief of pain.
In saying that, a patient will typically be able to safely return to work and physical activity after an osteotomy.
The two most important factors contributing to the success of a tibial osteotomy are the weight of the patient and the angular correction of the surgery. If the two are ideal the outcome is about 70% of patients should not require any major surgery for the next 10 years.
There are potential complications involved with osteotomy surgery. These include wound problems, infection, delayed or incomplete bone healing, injury to major nerve and blood vessels, compartment syndrome, irritation from metal work and fracture into the knee joint. However, the incidence of complication is low. Potential complications following osteotomy surgery tend to be lower than those associated with joint replacement surgery and the complications are usually more easily dealt with compared to potential complications following a knee replacement.