Knee osteotomy can prevent or delay the need for a knee replacement

Knee osteotomy or knee replacement

Although age is still a critical factor in the progression of knee osteoarthritis and the need for a knee replacement, we are seeing increasing numbers of younger patients presenting with advanced wear and tear of the knee joint. Physically demanding careers, active lifestyles, a boom in high-intensity sports and rising obesity levels all play a role.

Conservative management such as painkillers, injections, a knee brace, physiotherapy and an exercise programme can reduce symptoms and it is important that these options are optimised before considering surgery. When non-operative options fail to relieve pain and stiffness, surgery can alleviate the symptoms of knee osteoarthritis and restore the high level of function desired by the younger patient.

Although improvements in implant materials and technological advances such as the Mako Robotic-Arm Assisted software are positively impacting joint replacement longevity, total knee replacement (TKR) in younger patients is associated with a high risk of future revision surgery. However, if only one compartment of the joint is affected, another option is knee osteotomy, which redirects the load passing through the relatively unaffected compartment.

This procedure has recently been in the spotlight, as BBC news presenter Karin Giannone announced she would be off air for a while, recovering from an osteotomy operation.

The 50-year-old news anchor is an avid runner and revealed she had needed the procedure for many years but hoped to be “up and running again” very soon.

As in Karin’s case, a knee osteotomy is usually recommended for younger patients who are still active with early-stage knee arthritis. This option delays the need for a knee joint replacement and allows younger patients to maintain an active lifestyle for many years, whereas a TKR may restrict what activities they can enjoy, such as high-impact sports. If arthritis progresses, a knee replacement remains an option in the future.

Patients who undergo osteotomy can typically expect to achieve the same or higher levels of pain relief and function than patients who undergo a knee replacement but without the long-term implications of being committed to an artificial knee for life and the potential need for revision surgery.

Knee osteotomy or knee replacement?

A recently published Canadian study found that a knee osteotomy could delay the need for a knee replacement by ten years or even more.

The tibia or shin bone is reshaped during the procedure to relieve pressure on the knee joint. Correcting alignment shifts the load to the less diseased part of the knee joint, improving pain and function.

The researchers found that of nearly 600 patients who underwent a high tibial osteotomy, 95% did not need a total knee replacement within five years, and 79% did not need one within ten years. Knees treated at the earliest stages of osteoarthritis had the highest longevity, with 87% not requiring a TKR within ten years.

Even in patients not usually considered good candidates for high tibial osteotomy, such as women and those with later-stage disease, 70% did not need a knee replacement within ten years, the researchers found.

Mr Neil Hunt analysed more than 600 osteotomies while on fellowship in Australia in 2003 and found that at 5-12 years of follow-up, fewer than 20 of those patients had needed to undergo knee replacement.

Knee osteotomy is not widely offered by many knee surgeons; it requires very specialist training as well as careful planning and thought yet it provides a viable alternative with many potential benefits to younger patients. Some patients may not be suitable for the procedure – patients must keep their weight off the knee for at least a month after an osteotomy, so they must be strong enough to use crutches, for example.

Neil always considers osteotomy as a surgical option for suitable patients and regularly performs this surgery. His patients who have undergone this procedure have reported the benefits of being pain-free and of enjoying being able to return to an active lifestyle including skiing, hill-walking (one patient recently enjoyed a 27 mile walk in the Lake District), climbing in the Alps and playing football with their grandchildren.

If you would like more advice on whether you are suitable for a knee osteotomy, you can make an appointment with Mr Neil Hunt at one of his clinics or call Charissa Sullivan on 07724 909 414.