Knee Osteotomy Singapore

Knee osteotomy is a strategic orthopedic surgery aimed at correcting misalignment and relieving discomfort in the knee, often employed for patients with localized arthritis or specific structural knee issues.

  • Are your knee pain symptoms affecting your quality of life? Consult our MOH-accredited knee osteotomy specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What Is Knee Osteotomy?

Knee osteotomy is a surgical procedure that realigns the knee joint to alleviate pain and improve function, primarily in patients with arthritis or knee deformities. It involves cutting and reshaping either the tibia (shinbone) or femur (thighbone) to redistribute weight and pressure across the knee, delaying the need for more invasive joint replacement surgery.

Types of Knee Osteotomy

High Tibial Osteotomy (HTO)

High Tibial Osteotomy is performed on the shinbone and is commonly used to treat arthritis in the knee’s medial (inner) compartment. This procedure realigns the knee by shifting the weight from the damaged area to the healthier part of the knee.

Distal Femoral Osteotomy

Distal Femoral Osteotomy is performed on the femur (thighbone), typically to correct knee alignment in patients with valgus deformity (knock-knees). This procedure adjusts the weight-bearing line of the knee, shifting it away from the damaged area.

Preoperative Considerations for Knee Osteotomy

  • Patient Evaluation and Diagnosis: The preoperative evaluation for a knee osteotomy involves a thorough assessment of the patient’s medical history, focusing on the duration and severity of knee pain, previous injuries, and any prior treatments. A physical examination is conducted to assess knee stability, alignment, range of motion, and the presence of any deformities. This evaluation helps in determining the suitability of the patient for the procedure.
  • Imaging and Planning: Imaging studies, including X-rays, MRI, and CT scans, are crucial for accurate diagnosis and surgical planning. These images help in assessing the extent of joint damage, the degree of misalignment, and the overall structure of the knee. Modern imaging techniques are used to create a detailed preoperative plan, which guides the surgeon in making precise corrections to the knee alignment.
  • Risk Assessment: Risk assessment involves evaluating the patient’s overall health status, including any comorbidities that may affect the surgery or recovery. Patients are counseled about the potential risks and benefits of the procedure, the expected outcomes, and the rehabilitation process. This counseling ensures that patients have realistic expectations and are fully informed about the commitment required for successful postoperative recovery.

Knee Osteotomy Surgical Procedure

Anesthesia Options

Knee osteotomy can be performed under general anesthesia, where the patient is completely asleep, or spinal anesthesia, which numbs the body from the waist down. The choice of anesthesia is based on the patient’s health, preferences, and the surgeon’s recommendation. The anesthesiologist will discuss these options with the patient before the surgery.

Step-by-Step Surgical Procedure
  • Incision: A small incision is made near the knee to access the bone.
  • Bone Cutting: Depending on the type of osteotomy, either the tibia or femur is partially cut.
  • Bone Realignment: The bone is then realigned to correct the knee’s alignment.
  • Fixation: The new position of the bone is secured using plates and screws.
Opening Wedge Technique

In the opening wedge technique, a wedge-shaped space is created in the tibia. This space is then filled with a bone graft or a synthetic material to maintain the new alignment. This technique allows for precise correction and is often used for smaller adjustments.

Closing Wedge Technique

The closing wedge technique involves removing a wedge of bone, usually from the outer side of the tibia. The remaining bone ends are then brought together and secured, realigning the knee. This method is preferred for larger corrections and offers a quicker healing time.

Use of Bone Grafts and Implants

Bone grafts, either from the patient’s own body or a donor, are often used in opening wedge osteotomies to fill the created space. Synthetic materials can also be used as alternatives to natural bone grafts. Implants, such as plates and screws, are used to stabilize the bone in its new position until healing occurs. These implants are designed to be strong and compatible with the body’s tissues.

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Postoperative Care and Rehabilitation After Knee Osteotomy

  • Immediate Postoperative Care
    After a knee osteotomy, patients are typically monitored in a recovery area. The focus is on managing vital signs, preventing infection, and ensuring the stability of the knee. The operated leg is often elevated to reduce swelling, and a brace or cast may be applied to immobilize the knee temporarily.
  • Crutches or Assistive Devices
    Post-surgery, patients are often required to use crutches or other assistive devices. The duration for which crutches must be used varies based on the individual’s healing process and the type of osteotomy performed. Typically, crutches are used for several weeks to avoid putting full weight on the operated leg.
  • Pain Management Strategies
    Pain management is a critical aspect of postoperative care. Patients are usually prescribed a combination of pain medications, which may include opioids, NSAIDs, and local anesthetics. The use of ice packs and elevation can also help in reducing pain and swelling. Speak with your orthopaedic surgeon about your pain levels for effective management.
  • Rehabilitation Protocols
    Rehabilitation begins soon after surgery to aid recovery. Initially, the focus is on gentle exercises to improve range of motion. As healing progresses, more intensive physiotherapy is introduced to strengthen the knee and improve flexibility. The rehabilitation program is tailored to each patient’s specific needs and recovery goals.
  • Return to Normal Activities
    Returning to normal activities is a gradual process. Patients are advised to slowly reintegrate daily activities based on their comfort and ability, following the guidance of their physical therapist. The timeline for returning to activities such as driving, work, or sports is personalized based on the patient’s progress in rehabilitation, type of job, and the sport they play. Regular follow-up appointments are necessary to monitor the healing process. 

Risks & Complications of Knee Osteotomy

Knee osteotomy, like any surgical procedure, carries certain risks and potential complications.

  • Infection - As with any surgery, there is a risk of infection at the incision site or within the knee joint.
  • Blood Clots - The surgery can increase the risk of blood clots, particularly in the legs (deep vein thrombosis) which can potentially travel to the lungs (pulmonary embolism).
  • Nerve or Blood Vessel Damage - There is a possibility of damage to nerves or blood vessels around the knee during surgery.
  • Nonunion or Delayed Healing - The cut bone may fail to heal properly or take longer than expected to heal.
  • Undercorrection or Overcorrection - There is a risk that the realignment of the knee may not be optimal, leading to continued pain or other issues.
  • Implant Problems - Complications related to the plates and screws used to stabilize the knee, such as loosening or breakage, can occur.
  • Stiffness and Loss of Range of Motion - Some patients may experience stiffness in the knee joint post-surgery.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    FAQs Regarding Knee Osteotomy

    How Long Will I Need to Use Crutches?

    Patients typically use crutches for several weeks post-surgery. The exact duration depends on the type of osteotomy and the individual’s healing process.

    Can I Avoid Knee Replacement Surgery with Osteotomy?

    Knee osteotomy can delay the need for knee replacement surgery, especially in younger patients. It is not a permanent solution but can effectively manage pain and improve function for several years.

    Will I Have Scars After Surgery?

    Yes, there will be surgical scars, but they typically fade over time. The size and visibility of the scars depend on the specific surgical technique used.