Osteoarthritis: Surgery for Joint Pain Relief

Osteotomy for Joint Pain Relief

Osteotomy may be called for when joint replacement surgery is ruled out or when severe Osteoarthritis causes:

• More knee joint damage on one side than the other, leading to a bow-legged or knock-kneed deformity, or
• Abnormal bone alignment of the hip joint

Joint replacement surgery may also be ruled out if the patient is too young.

In the knee, osteotomy involves removing a wedge of shinbone from beneath the knee's healthy side. This changes the angle the shinbone makes, causing a shift in weight bearing areas. As a result, the shinbone and thighbone bend away from the direction of the deformity.

In the hip, osteotomy is usually done for patients with early arthritis of the joint -- for example, infants with hip dysplasia (abnormally formed hip joints) that leads to osteoarthritis.

Because osteotomy is done more often on the knee, this article focuses on the knee.

Benefits and Risks of Osteotomy

Besides helping to correct the knee deformity, osteotomy may help:

• Relieve joint pain and symptoms
• Slow the progression of osteoarthritis by changing body-weight stress on the damaged portion of the knee
• Delay the need for joint replacement in younger, active patients with painful osteoarthritis

Unfortunately, it's difficult to know for sure which patients may benefit from osteotomy. Poor outcomes are seen in patients who are not good candidates, including those with:

• Osteoarthritis throughout the knee, not just on one side
• Knee instability or shinbone dislocation
• Severely restricted knee movement
• Inflammatory arthritis (such as rheumatoid arthritis)
• Severe, hard-to-correct deformity

What Happens During Osteotomy

Using a 4- to 5-inch incision, the surgeon removes a small wedge of your shinbone from underneath the healthy side of your knee. This lets the shinbone and thighbone bend away from the damaged cartilage. It also helps keep damaged knee and shinbone surfaces from rubbing against each other.

After the surgery, you'll spend at least two hours in the recovery room. Most patients spend two to four days recovering in the hospital.

Osteotomy Recovery: What to Expect

The knee will be bandaged and iced. It's common to have night sweats and/or a fever of up to 101¡ãF. You'll receive pain medicine orally or intravenously. At home, be sure to take your pain medication as directed.

You may have a lot of pain at first. You'll be given pain medicine, either orally or through an IV (intravenous) line, as well as instructions as to what to do over the next couple of days.

As soon as possible, while still in bed, expect to begin flexing and extending your leg to keep it from stiffening. This may be done using a continuous passive motion (CPM) machine.

Once the incision closes (in about six days), you may be fitted with a knee brace, or the surgeon may cast your knee for four to six weeks. Physical therapy can usually start six to eight weeks after the surgery.

Note: A procedure called hemicallotasis may be done as an alternative to knee osteotomy. The surgery involves cutting partway through bone, then pinning an external frame to the knee to hold the gap apart and allow it to be slowly widened by twists of the pins over time. This encourages new bone to grow into the gap.

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