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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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What do you think of the surgery called osteotomy as a stop-gap measure for me? I want to avoid having a knee replacement. I only have arthritic changes on one side of the joint and I'm only 52-years-old.

Younger adults (65 or younger) who want to delay or avoid a total knee replacement may have other treatment options. One of these options is a surgical procedure called osteotomy. In this procedure, a pie-shaped wedge of bone is removed from one side of the tibia (lower leg bone). The osteotomy is usually done at the upper end of the tibia just below the knee. There are two different methods: the opening-wedge medial osteotomy or the closed-wedge lateral osteotomy. These are done on opposite sides of the knee. The goal is to change the angle of the knee and thus alter the weight-bearing pattern. Who can benefit from this approach? Well, as the technique describes, patients who put too much weight on one side of the knee might do well with this type of osteotomy. By shifting the weight more towards the middle of the knee, ground forces up through the foot when walking are evened out. The result can be to prevent medial (most common) or lateral compartment arthritis and put off (or even eliminate) the need for a joint replacement. This surgery is not usually recommended if the patient can't bend the knee past 70 degrees or has an unstable knee joint. Instability is judged by how much the tibia can slide back and forth under the femur (thigh bone). More than a one-centimeter subluxation (movement toward dislocation) can be a reason to exclude patients. These findings are more suggestive of someone who really needs a joint replacement and wouldn't benefit from an osteotomy. Your orthopedic surgeon is the best one to advise you on this. He or she will take into account results from X-rays, MRIs, and arthroscopic exam to determine what you need. Your age, goals, and activity level are important factors. You may be a good candidate for this type of surgery but if not, there are other treatment options as well such as a hemiarthroplasty (to replace just the arthritic side).


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