Knee Realignment Surgery (Osteotomy)
What is Knee Realignment Surgery (Osteotomy)?
Knee osteotomy involves carefully cutting and repositioning the femur or tibia to change the alignment of the lower limb. The aim is to shift load away from a damaged part of the knee and onto the healthier side of the joint. Osteotomy is a joint-preserving procedure that, in the right patient, can significantly reduce pain, improve function and delay or avoid the need for joint replacement by many years.
The main osteotomies around the knee are:
• High tibial osteotomy (HTO): for medial compartment overload associated with varus (bow-legged) alignment, often in combination with medial cartilage damage or medial meniscal deficiency.
• Distal femoral osteotomy (DFO): for lateral compartment overload associated with valgus (knock-kneed) alignment.
• Tibial tubercle osteotomy (TTO): for patellofemoral malalignment, typically combined with MPFL reconstruction in patients with recurrent patella instability or patellofemoral arthritis.
• Derotational osteotomy: to correct abnormal rotational alignment of the femur or tibia that contributes to patellofemoral symptoms or knee pain.
Who is suitable?
Knee osteotomy is considered for:
Dr Stoita will review your symptoms, activity goals, and any existing imaging. A detailed clinical examination is performed to confirm the diagnosis and discuss whether this procedure is the right option for you.
Initial visitX-rays, MRI or other imaging may be used to confirm the diagnosis and assess the extent of the condition. In complex cases, 3D computerised modelling may be used to assist with surgical planning.
Pre-surgeryThe procedure is performed under anaesthesia using the most appropriate surgical technique for your condition. Dr Stoita uses minimally invasive approaches where possible to reduce recovery time and optimise outcomes.
Day of procedureProtected weight bearing is required for 4–6 weeks to allow bone healing. Range of motion and physiotherapy are started early during this phase.
Full weight bearing is generally achieved by 6–8 weeks as bone healing progresses.
Return to sport is typically expected at 6–9 months depending on progress and the demands of the activity.
Frequently Asked Questions (FAQ)
In a total knee replacement, the entire knee joint surface is replaced – the ends of the femur (thigh bone), tibia (shin bone), and usually the underside of the kneecap are all resurfaced with artificial components. In a partial knee replacement (PKR), also called unicompartmental knee replacement, only the damaged compartment of the knee is replaced, leaving healthy bone, cartilage, and ligaments intact.
Diagnosis involves understanding a history of your symptoms, examining your knee, and using imaging such as X-rays to assess cartilage wear and joint alignment. In some cases, additional scans such as CT or MRI scans may be required to either exclude other conditions or quantify the degree of arthritis.Some patients develop patellofemoral pain syndrome in the absence of any bone, joint or soft tissue abnormalities. However, most patients with the syndrome present with one or more abnormalities related to bone anatomy, joint anatomy and/or soft tissue.
Although knee arthritis can affect anyone, there are several factors that can increase the risk of arthritis:
- Genetic predisposition
- Previous knee injury or surgery
- Other joint conditions such as rheumatoid arthritis or gout
- Occupations involving heavy manual work
- Age (over 40)
- Female gender
- Being overweight or obese
- Participation in high impact activities or sports (e.g. running, soccer or rugby)
Knee arthritis typically develops as a result of progressive cartilage wear within the joint. This process may occur naturally with age or be accelerated by factors such as previous injury, altered joint alignment, or increased mechanical load.
In some cases, inflammatory conditions such as rheumatoid arthritis can also contribute to joint degeneration.
