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I think I'm having something like "buyer's remorse" -- you know, where you buy something and then regret the purchase. What I "bought" was a surgery called high tibial osteotomy for my knee arthritis. I only have the arthritis in one knee and only on the half of the joint closest to the other knee. Now I'm wondering if I was too hasty. What if it doesn't work? Maybe I should have just had the knee replaced. I don't know -- I'm in a big muddle in my mind. What do other people think who have this procedure done?
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We can share with you the results of one surgeon who performed 455 high tibial osteotomies in patients with medial compartment osteoarthritis and then surveyed long-term results up to 19 years later. Let's review first the type of surgery: high-tibial osteotomy refers to a surgical procedure where the surgeon removes a wedge-shaped piece of bone from one side of the tibia (lower leg bone). The word "high" tells us the wedge is taken out of the tibia at the top of the bone near the knee (rather than down low by the ankle).
There are different ways to do a wedge osteotomy -- the bone can be removed from the medial side of the tibia (side closest to the other knee) or from the lateral side (opposite the medial side or the side away from the other knee). The patients in this study all had a high-tibial lateral closing osteotomy. You know that a high osteotomy refers to where the bone is removed from (upper part of the tibia).
A lateral osteotomy is taken from the outside edge of the tibia. A "closing" osteotomy means the two remaining edges of bone are shifted together (the hole made by removing the bone is closed). The goal of a lateral open osteotomy for medial compartment osteoarthritis (MCOA) is to shift the weight off the medial side of the joint. By shifting the weight-bearing load, the medial joint surface gets a break and the tension on the knee ligaments can be corrected.
The surgeon who did the operations wanted to know several things: 1) did the procedure hold up over time? 2) what factors helped predict success or failure? and 3) were the patients satisfied enough that they would do it all over again if they had the chance? It sounds like that's what you would like to know about other patients who have had this procedure.
They found that 85 per cent said they were satisfied with the results and would have the same procedure again if they had it to do all over again. There were some complications in a few patients with blood clots to the lungs, deep vein clots in the legs, hematoma (pocket of blood) pressing on a nerve, and bone nonunion. One-third of the group did have a second surgery -- either to revise the osteotomy or to replace the joint.
The conclusion was that high-tibial osteotomy is an effective way to treat medial compartment osteoarthritis (MCOA) of the knee. Studies have shown that the joint cartilage that's worn down can regrow when pressure is eased off that area. Results do deteriorate over time but many patients buy as much as 15-years of time before needing a total knee replacement.
When you are under age 50, that's a pretty significant benefit of the procedure. Reduced pain, improved function, and better quality of life make this a viable treatment option for younger, more active adults who aren't quite ready for a knee replacement.
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