Osteoarthritis of the knee joint, corrective osteotomy

Corrective osteotomies of the knee joint are used

• as an independent method of treating degenerative-dystrophic pathologies of large joints, for some infectious diseases of bones and congenital pathologies;
• as part of one of the stages of complex treatment of arthrosis of various etiologies, at the final stage of which the joint is replaced with an endoprosthesis.

What is corrective osteotomy of the knee joint?

This is a surgical intervention in which, through surgical manipulation of the tibia or femur, the effect of shifting the circular axis of load distribution on the lower limb and giving it a more physiological position is achieved.

The operation corrective osteotomy found its rebirth in the early 2000s; until that time, knee arthroplasty . Recently, the point of view has triumphed that while the patient is relatively young (up to 60 years), the regenerative features of his body are relatively great, and irreversible changes have not yet occurred in the knee itself, leading to its almost complete immobility and wear of the working surfaces over a large area, corrective osteotomy will allow a person to preserve his own joint with a minimal amount of surgical access. At the same time, in the postoperative period, complete restoration of knee function is possible while maintaining all types of physical activity and without reducing ability to work.

Main stages of surgery

The effect of surgery depends on the correctness of its implementation, preliminary diagnosis, the identified degree and the required level of correction. The operation is performed by a surgeon or orthopedist.

If the doctor does not collect the necessary evidence, then it is better to contact another specialist, since violation of the surgical technique will not bring positive results, but will only accelerate the destruction of the knee joint.

Preparation stage

Preparation should begin with a thorough diagnosis of the patient's condition. This requires laboratory and clinical research. The most important data will be obtained by radiography, tomography (computer or magnetic resonance imaging).

Digital radiography helps to obtain a clear, detailed picture of the axial abnormality of the leg.

Tomography will show the slightest disruption of the joint tissue. After studying the information received, the doctor can simulate postoperative results. The specialist receives comprehensive information about the degree of deformation of the axial line and the relationship between the angles of the lower extremities.

Preparatory stage

During the consultation, the doctor always explains the operation plan, at the patient’s request, explains unclear details, warns about the likelihood of complications and the need for rehabilitation. Then the optimal way to organize the operation, the size of the incision and the type of fixation are selected.

The patient begins to be prepared for surgical treatment. It is forbidden to take any medications during the week.

Operation stage

Modern surgery has several correction methods that differ in their technical characteristics. However, the implementation stages do not change:

1. A portion of the bone is excised using the necessary instruments. The edges of the bone are moved apart to a distance pre-calculated by the doctor.
2. An artificial implant or its own fragment, which is taken from the pelvic part, is installed in the gap. The size is also calculated in advance.
3. Metal plates, usually titanium, are placed over the connection. They firmly hold the resulting structure. For additional fastening, spokes and posts are used. Correct fixation allows you to create a stable angle when moving.
4. The operation must be monitored by X-rays to monitor how correctly the fracture is made and the fixation is carried out.

When the surgery is performed by professionals, the kneecap and tendons above the knee are left intact. Blood flow in the knee area also improves, cartilage tissue is restructured, and joint pain recedes.

Rehabilitation stage

The rehabilitation period corresponds to the condition in which the person is after surgery, as well as the quality of the bone fixators. Estimated times range from 12 weeks to 12 months. In the first 2 months, intensive fusion of bone tissue and bones occurs, the gaps are filled with new connective tissue. The remaining time is required to return the usual mobility of the leg and strengthen the structure.

In the first days of rehabilitation, only partial load on the installed structure and limb is allowed.

The doctor must check the level of normalization of the leg axis. Complete adaptation to the new position of the knee is observed in the 6th month after surgical treatment.

In modern medicine, this operation is considered a high-tech and at the same time simple correction method. It helps to postpone endoprosthetics for many years (more than 10 years), and becomes a kind of preparation for arthroplasty.

What types of damage are treated?

With gonarthrosis, there is an uneven distribution of load on the articular surfaces. Most often there are two types of such distribution:

• varus deformity of the limbs (legs - “wheel”) is the most common type of pathology in which the internal surfaces of the joint are affected;
• valgus knees (X-shaped) - when the outer surfaces of the joints are worn out.

The operation is performed only if the articular surfaces are damaged unevenly, on only one side of the knee. In the case of total damage (as in rheumatoid arthritis), the intervention in question is completely useless and absolutely contraindicated.

The essence of the operation and the result

The main goal of the intervention is to distribute pressure and friction evenly across the knee joint, reducing this impact on the most affected areas by loading those that are more preserved and functional.

As a result, the axis of the load on the limb is shifted, giving it a more physiological position, and, as a result, a more balanced distribution of the load (and let us remember, when walking it is about four body weights on one knee, when running - about eight), and reducing pressure on the “sick” area of ​​the joint surface.

Advantages of the method

• Relatively low invasiveness of the intervention. Surgical access is achieved by making an incision of only about one centimeter;
• follows from the previous one. This manipulation does not always require anesthesia, and in the vast majority of cases it is performed using regional, spinal or epidural (less often) anesthesia;
• as a result of the manipulation, the patient is discharged from the clinic with his knee completely preserved, and, subject to a number of conditions, a complete restoration of its functions is possible;
• the duration of the operation is about one and a half hours, it is well studied, with many years of experience;
• length of hospital stay is about three days;
• the time to return to the full range of activity of the limb is about two months.

Which is preferable: knee replacement or corrective osteotomy?

This question can be encountered in discussions both among patients and in the professional community. Although, objectively, the question of choosing between these manipulations can only be decided if there are contraindications to surgery using the corrective osteotomy method .

In all other circumstances, there are usually two options:

• corrective osteotomy of bones cannot have an alternative in the form of endoprosthetics, since it is aimed at solving completely different problems and is prescribed for other indications;

corrective osteotomy cannot be replaced with prosthetics, since it is only a stage in the strategy of therapeutic measures, the final of which will be knee replacement.

Treatment by the best specialists

will do everything to make your treatment as effective as possible. We cooperate with leading German clinics and can recommend a doctor who specializes in your problem. One of the unique German doctors whose specialization is osteotomy is Doctor of Medical Sciences, orthopedic traumatologist Sven Scheffler. His assets include:

• cooperation with the Olympic Sports Center;
• creation of a unique new concept “Return to Sports!”;
• treatment and rehabilitation of players of professional football clubs in Germany, Russia, Ukraine, Belarus, etc.;
• treatment and rehabilitation of professional handball players, volleyball players, gymnasts, boxers, etc.;
• annual performance of about 800 surgical interventions;
• active scientific activity (author of more than 50 scientific papers).

Dr. Scheffler is a worthy representative of world-famous German medicine. He treats both professional athletes and ordinary people. Our specialists will help you get treatment from the best doctors in Germany!

Why is it worth coming to Germany for treatment?

In addition to the general reasons and advantages of treatment in Germany, which we described in this section of the site, in Germany doctors never refuse to treat patients who have already come to their clinic for treatment. If the doctors agreed to accept you for treatment, then they will not send anyone home, but will fight until they defeat the disease. When deciding on the need to use a particular technique, German doctors proceed from the patient’s condition and the appropriateness of treatment, but never refuse further treatment only because of the patient’s age or condition, as is often the case in post-Soviet countries. If it becomes obvious that it is no longer possible to stop the progression of the disease, the patient is offered a well-thought-out program to alleviate suffering and remove pain as much as possible.

Indications for surgery

• age – up to 60 years. At a young age, tissue regeneration, and therefore rehabilitation, occurs faster and more reliably. In old age, the operation of choice is complete joint replacement with an endoprosthesis;
• no signs of obesity. Excess weight will negate all the positive effects of the operation very quickly, and the relief will be short-lived. A vicious circle is started: excess body weight, as a result, increased load on the knee, resulting in a recurrent course of arthrosis;
• rachitic changes in bone tissue. Provides both a reduction in wear on the surfaces of the knee joints and the correction of cosmetic defects;
• deforming arthrosis, gonarthrosis. Together with other recommendations, this is the main and main indication;
• improperly consolidated fractures of the lower extremities and shortening of one of the lower extremities - the principle is the same. Redistribution of the load followed by automatic alignment of the limbs;
• osteomyelitis. When treating this pathology, the infected area of ​​the bone is excised and replaced with an autoimplant. Thus, the focus of the purulent process is removed, and due to autoimplantation of bone tissue, regeneration processes are accelerated.

The surgical plan for hallux valgus deformity is drawn up strictly on an individual basis.

When treating Hallux valgus, concomitant diseases are also taken into account

• Exostosis on a bump
• Arthrosis of the first metatarsophalangeal joint (Hallux rigidus).
• Bursitis is an inflammation of the mucous bursae in the joint area.
• Bursitis of the small fingers.
• Transient metatarsalgia (painful overload of the small fingers)
• Hooked fingers
• Hammer fingers

Hallux valgus always occurs in combination with various painful processes. So, in addition to valgus deformity of the 1st finger, the patient may experience skin changes or inflammation of the mucous bursa (bursitis). The crooked toe displaces the neighboring little toes, as a result of which it is subject to overload. Before drawing up a surgical plan, our clinic’s specialists will conduct an accurate diagnosis and determine the degree of development of the disease. Below, standard operations for hallux valgus deformity will be presented to your attention in detail. In addition, we draw your attention to the fact that with this disease, in order to refer the patient for surgery, we first need to understand his individual situation and assess the degree of hallux valgus.

Surgical treatment of hallux valgus is performed only by highly qualified specialists with many years of experience. The surgeon discusses all the details and features of the upcoming intervention with the patient in advance.

The purpose of corrective osteotomy of the knee joint

There may be several ultimate goals set by an orthopedist when prescribing surgical treatment, and they depend on the strategic objective:

• can be used as a long-term complex therapy for arthrosis - as an intermediate link in a chain of sequential changes in treatment tactics, from conservative and physical treatment to radical joint replacement;
• used as an independent and main method of treatment for incorrectly consolidated fractures, to eliminate congenital and acquired cosmetic defects of the lower extremities, in the presence of ankylosis and false joints.

Restoring support function

Surgeries aimed at creating a weight-bearing, painless joint are mainly used for coxa vara/valga, neoarthrosis of the femoral neck, chronic cervical fractures, congenital dislocations, and osteoarthrosis. The problem of restoring a supporting function convenient for walking and standing is often solved by changing the axis of the femoral neck. The altered neck-shaft angle changes the fulcrum of the head, which was initially pathological, by several millimeters (up to 15 mm). This approach favors not only the restoration of weight-bearing ability, but also decompression of the joint and reduction of pain symptoms. The cutting of the femur is carried out in the most appropriate way, which is selected on the basis of individual radiological data.

How is the operation performed?

The meaning of the surgical intervention is that an incision is made on the bone on the side of the greatest damage to the joint, a hole of the required shape. After this, the required amount of one’s own bone or cartilaginous substance is placed into this hole, due to which the limb is, as it were, retracted to the side, deviated along the axis of the body in the direction opposite to the pathological process.

Osteotomy with metal structure

Next, the area of ​​the bone where the incision was made with the bone autoimplant placed there is fixed with a titanium plate using screws . Then the access is sutured, and the limb is immobilized using a splint or splint. There is no need to apply plaster.

Types of surgical techniques

• by type of access - open and closed. There are situations when open access, despite being more invasive (when the bone surface is exposed and the incision width is 10–12 centimeters), is preferable. The need for this type of intervention is due to the increased risk of damage to nerves and blood vessels during surgery;
• by level of implementation of interventions. Depending on the location of the pathological process and the goal, excision is performed on the femur or tibia. On the latter, in turn, high and low tibial osteotomies are performed;
• according to the method of excision of bone tissue - wedge-shaped, transverse, straight, oblique, spherical;
• by the nature of the correction - opening, closing.

Knee osteotomy: visual representation of the procedure.

Most common complications

Sawing bones is a serious operation that involves considerable risk. Undesirable complications can develop during the manipulation or already during the recovery period. Many of them are difficult to treat.

Table 1. Possible complications

Rehabilitation

Rehabilitation measures after corrective osteotomy of the knee joint using plates with angular stability usually last no more than four weeks. There are often cases when the period of rehabilitation measures can increase significantly. This is due to the individual characteristics of the patient, but the largest share in such cases is due to ignoring the recommendations of the attending physician and non-compliance with the conditions and timing of the postoperative period. If you strictly follow the rehabilitation plan, the chance of developing complications or delaying the healing process is minimal.

The patient begins to perform the first sets of physical therapy exercises while still in the hospital (the inpatient treatment phase takes from three days to a week). In the postoperative period after corrective osteotomy of the knee joint, rehabilitation measures are aimed primarily at restoring blood circulation and maintaining full trophism of the limb. At this time, exercises for bending and extending the leg at the knee, massages of the feet and hips, symptomatic, restorative, antibacterial therapy and anticoagulants, cold on the leg are indicated. The patient walks on crutches (about three months); putting weight on the operated limb is absolutely contraindicated.

The main role in rehabilitation belongs to physical therapy. The load on the joint should be gradually increased. The number of exercise therapy exercises and their duration increase; at later stages, exercise classes on an exercise bike and swimming are prescribed. During the recovery period, physiotherapeutic procedures are required.

The entire period of rehabilitation and full restoration of performance takes from six months to a year.

General concepts

The osteotomy operation is performed by highly qualified trauma surgeons. At first glance, it seems that the intervention is complex and requires a lot of time for the patient to recover, but following the doctors’ recommendations will quickly get the patient back on his feet.

Osteotomy is an operation that is performed using special instruments - osteotomes, Gigli saws, electric saws and ultrasonic devices. They help make holes at the intervention site and cut through the bone tissue. After collecting the fragments, the bone fragments are fixed with screws, knitting needles, and plates. Unlike accidental fractures, a plaster cast is rarely applied to avoid the possible development of contractures in the joints.