Knee surgeon
Treatment

Osteotomies

Description

¿What are the osteotomies?

Osteotomies are procedures aimed at compensating for alignment imbalances of the lower extremities. These are very often underestimated in terms of their importance for a normal recovery of the knee. It is very common to see patients who come with one or more MRIs indicating a tear of the meniscus, when in many cases the meniscus is a victim rather than the cause of the problem. It is always necessary to assess the alignment of the lower extremities because an alteration in it can be a reason for a very bad result if it is not corrected or contemplated before proceeding to resect a meniscus.

There are many types of knee osteotomies. The most frequent are performed when the limb is deviated inwards (genu varus) or outwards (genu valgus), and the medial area in the varus, or lateral in the valgus, is damaged. When a leg is deviated in varus, there is an overloading in the medial area of the knee. The opposite happens in a valgus knee. Therefore, treating the problem of the damaged area exclusively in the knee without considering the load distribution across the joint is a big mistake, and one that leads to disappointing results. Unfortunately, it is something very frequently seen in patients who had not even assessed in the aspect with a mandatory long-standing radiography of the lower limbs. The main objective of this type of osteotomies is to improve function, reduce pain and delay the need to place a prosthesis. That is, it seeks to extend the life of the joint. This is achieved by correcting the axis of the affected lower extremity, shifting the weight load to areas of the knee that are intact.

It's not a big deal if you don't make it a big deal.

Surgery

Dr. Gelber first perform an arthroscopy to assess possible associated injuries and treats them when necessary. Then the osteotomy itself is done. 

Knee valgus osteotomy is one of the most commonly performed. Depending on the radiographic and clinical studies, the correction will be carried out on the tibia or the femur. Correction of the deformity can be obtained by adding a wedge in the medial area (open wedge osteotomy) or by resecting a wedge in the lateral area (closing wedge osteotomy). In cases of knee varus osteotomies, these seek to reduce or eliminate the previous valgus deviation. Similarly, correction should be made depending on where the deformity is located (femur or tibia). Unfortunately, it is very common to observe how valgus osteotomies are systematically performed only in the tibia, and varus osteotomies only in the femur. This leads to an incorrect correction in 40% of cases. Sometimes, the correction must even be performed on both bones simultaneously. Dr. Gelber is a world leader in this type of corrections, and regularly works as an instructor for other doctors in different countries around the world.

The need for this surgery depends on many factors, which will be explained in detail during the consultation. Typically, the patient should remain at the hospital for 1 or 2 days after surgery for appropriate pain control and first rehabilitation exercises.

After surgery

After surgery on the day of hospital discharge and before leaving for home, the patient receives all necessary information regarding postoperative care. The patient also leaves the hospital with an appointment for within 10 days or so to have the wound checked.

Rehabilitation

The main difference from the standpoint of rehabilitation between the two types of main osteotomies (open or closing wedge) is that the closing wedge osteotomy allows immediate or early loading of the limb. When open wedge osteotomies are performed on the femur, it requires the use of crutches for about 3-4 weeks to avoid weight bearing on the knee and thus allowing biological integration of the wedge. Generally, in these cases the patient can definitively stop using crutches between 6 and 8 weeks after surgery. In open wedge tibial osteotomies, however, thanks to the new fixation systems used by Dr. Gelber, loading can also be started immediately after surgery. In the other aspects of rehabilitation, all osteotomies seek the same objective, such as reducing inflammation, recovering full motion of the knee with special emphasis on extension, and recovering strength and muscle activity. Most patients obtain almost complete functional improvement between 4 and 6 months, although minor additional progress is expected up to one year after the intervention.

Postoperative exercises after a knee osteotomy depend on the type of osteotomy and whether it has been performed on the tibia or femur and whether it has been closing wedge (removing bone) or opening wedge (introducing a bone wedge). Ultimately it also depends on other associated surgeries performed at the same time, such as meniscus repairs or transplants, cartilage repairs or transplants, and ligament reconstructions or repairs. As a rule, recommendations are combined, with the most conservative of them always prevailing.

First general phase

Control of pain and inflammation

One notices that the knee is sore and swollen the first few days. To improve this, the recommendation is:

Open wedge high tibial valgus osteotomy

Closing wedge hight tibial valgus or tibial derotational osteotomies

Open wedge distal femoral varus osteotomy

Closing wedge distal femoral varus or femoral derotational osteotomy

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