High Tibial Osteotomy - A Joint Solution
In this article we'll talk about Osteotomy, which translates to "cutting the bone." By cutting the femur or tibia, then reshaping it, pressure is relieved from the knee joint.
The following is an excerpt form a paper I authored on HTO (High Tibial Ostemotomy) during my time with the Steadman-Hawkins clinic in Vail, CO
-Dr. Bill Sterett, Vail, Colorado
A more accurate solution #osteotomy
Over the last ten years, we have worked to realign the joint from the inner side – where the problem exists. This is much more accurate and restores length to the shortened leg.
While historically the result of a high tibial osteotomy (realignment) adds an average of approximately nine years to the life of the knee, we are hoping that by adding a chondral resurfacing procedure, and performing this procedure on the inner side of the knee, this will be an even greater improvement.
Conversely, in the right circumstances, adding an osteotomy procedure to a microfracture or meniscus implant will help “protect” this new joint surface for an even longer period.
The results of this new “opening wedge osteotomy” have been increasingly encouraging, to the point where we can now predictably realign the knee and resurface the joint in an attempt to put off the need for a knee replacement for an indefinite period of time.
Knee Preservation and Realignment: A Joint Solution
There is nothing more important in terms of how long a knee will last than the alignment of the leg. When we draw a line from the center of the hip down to the center of the ankle, that line should fall right in the center of the knee.
If this line passes through the inner half of the knee (bowlegged), as much as 60 percent of our weight will fall on the inner side of the knee and 40 percent on the outside. As the inner side of the knee starts to collapse, the line shifts over even further, putting more weight on the inner side.
“It is an exciting time in medicine for joint preservation, and this is an encouraging step. Anything we can do to put off the need for knee replacement and keep people actively doing the things they want to do for as long as they possibly can is going to be best for the person as a whole and should not be considered merely a “knee solution”
but rather a “lifestyle solution.””
By putting more pressure on the inside of the joint, we start wearing down the cartilage in that area. Articular cartilage is the cap of low-friction paint covering the end of the bone. For example, this is the smooth shiny substance that we see on the end of a chicken bone. Once this is worn down, we are then down to a bare bone-on-bone condition called arthritis.
Although there are many types of arthritis, osteoarthritis is the wear-and-tear phenomenon resulting in bone rubbing on bone. Our joints are no different than most other mechanical devices in that they will wear out with time depending upon the amount of use they see.
Obviously, if we put more use on one side of the joint vs. the other, that side will wear out more quickly. Our treatment options for a patient who has increased bowing of the leg along with arthritis on the inner side of the knee have improved dramatically over the course of the last seven years.
“Previously, patients had always been told, “Just wait until it’s bad enough, then have a joint replacement.” We now have a treatment plan for this problem.”
Non-Operative Management
Non-operative management includes nutritional supplements, anti-inflammatory medications therapy to strengthen the muscles, or possible injections and should be discussed.
When we consider surgical options for this type of problem, Dr. Steadman developed the chondral resurfacing procedure we commonly refer to as “microfracture.”
This surgical procedure involves making small punctures in the bone that underlies the damaged cartilage. These small punctures, or microfractures, provide access to the cells and healing factors contained in the bone marrow. These marrow elements are released and form a “superclot” which supports formation of new regenerate-cartilage.
Wear and Tear Arthritis with 12 week re-look following #Microfracture
Microfracture can do an excellent job of resurfacing the joint and “repainting” the end of the bone with this cartilage. Unfortunately, if the joint is out of alignment and the majority of the weight is put on the side that needs to be resurfaced, this will wear down much faster.
Therefore, instead of lasting seven to nine years, it might last no more than three to four years. These numbers can vary depending on the individual’s anatomy. The obvious next step, then, is to realign the joint and turn a bowlegged person into either a straight or even knock-kneed stance.
Previous techniques have been somewhat complicated, with variable results. Older procedures involved removing a wedge of bone from the outside portion of the leg to realign the joint. This technique was a limited “one shot” approach and would often shorten an already shortened leg.
Our options for joint realignment include an internal device, which would require patients to be non-weight-bearing for a minimum of eight weeks, or an external device, which would allow patients to bear weight somewhat sooner but is much more cumbersome and a little less user-friendly.
Both of these options should be discussed extensively before embarking on either!
For more resources, please visit www.drsterett.com and www.vsortho.com
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In this article Dr. Sterett talks about Osteotomy, which translates to "cutting the bone." By cutting the femur or tibia, then reshaping it, pressure is relieved from the knee joint...https://dr-william-sterett.squarespace.com/blog-dr-william-sterett/2015/7/16/high-tibial-osteotomy
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"It is an exciting time in medicine for joint preservation, and this is an encouraging step. Anything we can do to put off the need for knee replacement and keep people actively doing the things they want to do for as long as they possibly can is going to be best for the person as a whole and should not be considered merely a “knee solution” but rather a “lifestyle solution.” http://williamsterett.com/blog-dr-william-sterett/high-tibial-osteotomy
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