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Surgery for Knee Damage From Bow-Legged Deformity

Surgery can be done for patients with long-term wear and tear from having knock-knees. This condition is called varus deformity. Dr. Frank Noyes, a well-known orthopedic surgeon reports the results of 55 cases treated with an operation called opening wedge osteotomy or high tibial osteotomy (HTO).

This particular procedure is designed to help patients get their motion back quickly and get back on their feet without complications. The surgeon removes a piece of bone from the iliac crest (pelvic bone) to use as a wedge at the knee. The idea is to correct the deformity by changing the angle and slope of the tibia (lower leg bone).

During the HTO, the top of the tibia is sawed almost completely off. The bone is lifted up forming a sideways V-shaped gap. The bone graft is cut into three triangular shapes and carefully inserted into the opening.

A metal plate and screws are used to hold everything together while the bone heals. The goal is to promote healing and prevent nonunion or fracture. A special X-ray called fluoroscopy is used right in the operating room to check the angle of correction.

In this study fifty-five (55) patients who had an HTO were followed for at least six months after surgery. Healing and union at the osteotomy were seen on X-ray by three months for almost all 55 patients. By the end of 10 months all 55 had complete healing.

Quick healing of the osteotomy site allowed patients to get back to full weight-bearing by eight weeks. Many problems were prevented with this fast rehab schedule. Avoiding long weeks of crutch use and providing balanced bone and soft tissue also helped prevent further joint damage.

The authors review the results of other studies using bone graft in an HTO. They offer "technical pearls" to surgeons for avoiding complications in an HTO. Ideas for postoperative rehab program are also outlined.

References: Frank R. Noyes, MD, et al. Opening Wedge High Tibial Osteotomy. In The American Journal of Sports Medicine. August 2006. Vol. 34. No. 8. Pp. 1262-1273.

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