When to discuss osteotomy?

No, we’re not going to break your tibia! Osteotomy is performed around the knee on either the distal part of the femur or the proximal part of the tibia and changes the axis of the lower limb. It consists of weakening the bone to change its orientation and then fixing it in this new position with a rigid material. This fixation is essential in the initial phase. After a few weeks, the weakened bone consolidates and regains good mechanical properties over the following months.

Osteotomy is considered in people who are relatively young and often active

Osteotomy is rarely considered in people over the age of 60, and very rarely in people over the age of 70. The symptoms that lead to considering osteotomy are most often those associated with early osteoarthritis. It manifests itself as pain and joint effusion, which progresses through crises interspersed with periods of remission. Medication, intra-articular injections, weight loss and changes in physical activity often help to control the attacks. Rehabilitation prevents or delays new attacks. But over time, conservative treatment becomes less effective. Severe joint pain become more frequent and longer, while the remissions become rarer and shorter. The pain, which is now more difficult to control, and the limitation of activities lead to the discussion of surgical treatment. X-rays make it possible to determine the type of osteoarthritis and its radiological severity. But be careful: very advanced osteoarthritis is not always associated with disabling pain on radiographs and, conversely, unbearable pain is sometimes reported when the radiographic appearance is of little concern. There is therefore sometimes a radiological-clinical dissociation. Another way of expressing this, which is very popular with surgeons, is to say: We do not operate on X-rays, but on a patient who complains.

Morphological aspects to be considered

However, in many cases, when the symptoms are still mild, the morphological aspect may lead to a surgical decision before the osteotomy stage. Therefore, although the patient’s discomfort is an important factor, the anatomical and radiological assessment must also be considered. This is not just a matter of your acceptance of the pain and situation. Your surgeon’s advice is also important.

Osteotomy in sport.

In sports surgery, the osteotomy has been pushed to the limits of reconstructive surgery. Sometimes the aim is not to transfer forces from one compartment to another, but to reduce the forces in the repaired compartment. For example, an ACL graft, cartilage repair or meniscus graft can be protected by a concomitant osteotomy (during the same operation). The alignment correction performed during surgery is more common in athletes. This is also the case when the patient has an excessive constitutional deformity with pain and unsightly appearance. The damage is often bilateral. Treatment involves both knees. It is sometimes performed on both sides in the same operation.