(PICTURE 1: WEDGE OSTEOTOMY)
Why am I having a high tibia osteotomy?
The weight through your knee has been predominantly through the medial (inside) portion of the joint, which has caused this compartment of your knee to have become more worn away than the lateral (outer) side.
You may have noticed your leg beginning to look bowed – this is a result of the uneven wearing on the knee joint.
What is the procedure?
A high tibia osteotomy is a surgical procedure to realign the leg and reduce the pain you have from your knee by transferring the body weight to preserve the outer side of the knee joint.
A cut is made in the tibia (shin bone). The alignment of the tibia is carefully adjusted by levering open this cut in the bone until the desired alignment is reached. The bone is then fixed with a plate that is held in place with screws. This is called an opening wedge osteotomy (Picture 1). The triangular gap in the bone will be filled in with new bone over the next few months post-surgery.
This procedure does not return the knee to ‘normal’. Instead it prolongs the life of a damaged knee, helps relieve pain and delays the need for a total knee replacement.
What do I need to avoid doing?
After surgery you will have a brace on your knee for six weeks, although your initial brace might be changed after one to three weeks. Your knee will be held in extension (fully straightened position) for the first week. After this a bend will be gradually re-introduced to the knee through alterations in the brace settings. The speed of recovery of your knee bend will depend upon your specific surgery and your consultant’s guidelines. This will be fully explained to you by your physiotherapist.
Role of PHYSIOTHERAPIST
You will be taught to partially weight-bear for the first six weeks following surgery using elbow crutches. This will allow the knee to heal correctly and it is important to adhere to this. Your physiotherapist will teach you how to walk, and provide you, with elbow crutches. Some patients may be required to be non-weight bearing for the first two weeks after surgery – your physiotherapist will teach you how to do this if it applies.
Caution: Avoid removing the brace unnecessarily. The brace can be removed to wash as long as the leg is kept in a straightened position.
(PICTURE 2: STRAIGHTHENED LEG PRESERVED)
Will I need to do any specific exercises?
Exercises are important to complete to aid your recovery, minimize swelling and to improve the strength of the muscles surrounding the surgical site.
These exercises need to be completed at least three times a day, starting on the day of your operation. For the first six weeks these exercises need to be completed with your knee brace on.
Any additional exercises your physiotherapist feels are necessary will be discussed with you and taught individually.
· Lying on your back or sitting down. Pull your ankles up and down slowly then briskly. Repeat this 20 times. This exercise helps to prevent blood clots.
· Laying on your back with your legs straight point your toes up to the ceiling and push the back of your knee down firmly against the bed, (this exercise is known as static quads). Hold for five seconds, and then relax. Repeat 10 times.
· Lying in your back or sitting in a chair. Squeeze your buttocks firmly together and hold for five seconds then relax. Repeat 10 times.
· Laying on your back, and point your toes to the ceiling. Next, slide you’re operated leg out (abduction) to the side and then back to the starting position. You may need assistance initially for this exercise. Repeat 10 times.
· Straight leg raise: Start by contracting your quadriceps just like the second exercise. Then lift your leg off the bed. Repeat 10 times.
· Sit with your legs out in front of you. Place a long towel under the ball of your foot. Gently pull the toes towards the ceiling whilst holding onto the towel. You will feel a stretch along the back of your calf muscle. Hold this stretch for 15 seconds. Repeat three times.
· Sit on the floor or on a bed with your legs straight and your back supported. Slide the heel of your operated leg up towards you, keeping your heel in contact with the bed. Bend your knee as far as the brace will allow. Return to the starting position. Repeat 10 times.
(PICTURE 3: BEFORE AND AFTER SURGERY)
Will I receive ongoing physiotherapy?
When you are discharged, you will be referred for ongoing outpatient physiotherapy at your local hospital or private rehabilitation centers.
When can I return to normal activities?
The first two weeks after surgery should be dedicated to your recovery so you should not work at all during this time. It is realistic to start desk-based work at home after the third or fourth week, with the potential to return to the office for the odd half-day after six weeks and onwards provided your journey is manageable.
Returning to work full-time is usually possible after eight weeks, again depending on how physically active your job requires you to be.
Driving is not advised until you can walk unaided and put full weight through your operated leg.
This may be up to 10 weeks after your operation.