Tibial Osteotomy in Tunisia
Tibial Osteotomy
Knee osteoarthritis often affects only one side of the knee joint. When this occurs, realigning the angle made between the leg bones can shift your body weight so that the healthy side of the knee joint absorbs more stress. The procedure to realign the angles of the lower leg is called a proximal tibial osteotomy.
What parts of the knee are involved?
The knee joint is formed where the femur (thigh bone) meets the tibia (shin bone). Two bony knobs at the end of the femur, called condyles, rest on the top surface of the tibia. The inner condyle (closest to the other knee) is called the medial femoral condyle. The lateral femoral condyle is on the outer half of the femur (farthest from the other knee). The top of the tibia bone forms a flat surface called the tibial plateau.
The knee is divided into two halves or compartments. The medial compartment is the inner half of the knee and is formed by the connection of the medial femoral condyle and the tibial plateau. The lateral compartment is the outer half of the knee and is formed by the connection of the lateral femoral condyle and the tibial plateau.
Articular cartilage covers the ends of the bones. It has a smooth, slippery surface that allows the bones of the knee joint to glide over each other without rubbing. This smooth surface is designed to minimize pressure and friction when you move.
What happens during the operation?
There are two methods to realign the knee joint. One is to remove a wedge of bone; the other is to add a wedge of bone. Any operation where a bone is cut is called an osteotomy. In a closing wedge osteotomy, the surgeon cuts the tibia on the lateral side, removes a wedge of bone, and pins the open edges together. In an opening wedge osteotomy, the surgeon cuts the tibia on the medial side and opens a wedge, adding some bone graft to hold the wedge open.
Closing Wedge Osteotomy
In the closing wedge osteotomy, an incision is made on the lateral side of the knee to allow the surgeon to see the upper end of the tibia. Precautions are taken to protect the nerves and blood vessels that cross the knee joint.
Once the tibia bone is exposed, two cuts are made through the upper tibia in a wedge shape. The surgeon uses X-rays or a fluoroscope, a special type of X-ray machine that projects images onto a fluorescent screen, to ensure the wedge is the right size and properly placed.
Opening Wedge Osteotomy
In the opening wedge osteotomy, an incision is made in the medial side of the knee. Again, precautions are taken to protect the nerves and blood vessels that cross the knee joint.
Once the tibia bone is exposed, a cut is made through the upper tibia. A fluoroscope or X-rays are used to ensure the cut is in the right location.
Once the bone is cut, the two sides of the tibia are separated to form a wedge-shaped opening. This opening is then filled with bone graft. The bone graft is usually an artificial graft provided by various companies specializing in these types of products. The bone graft is held in position with a metal plate. After fixing both edges of the bone with a plate, the surgeon closes the skin and the leg is placed in a brace to protect the knee joint.
What happens after surgery?
Most patients can go home the same day. A tibial osteotomy at best is probably only temporary. This operation is thought to buy time before a total knee replacement becomes necessary. The benefits of the operation typically last seven years when successful.
What should I expect during my rehabilitation?
You will likely wear a knee brace for up to six weeks after surgery to protect the knee joint during your recovery. Your stitches will normally be removed in 10 to 14 days. Recovery after a tibial osteotomy takes two to three months.
During your recovery period, you should use your walker or crutches as directed. If you had a closing wedge osteotomy, you probably won't have to limit the weight you put on your foot. But with an opening wedge procedure, you will need to protect the healing bone graft by placing only the toes of the operated leg on the floor when walking. The surgeon will order a follow-up X-ray to see when the graft is safe for you to begin bearing weight when walking. This is usually six to eight weeks after surgery.
A physical therapist will begin helping you with treatment shortly after surgery. Your therapist may use heat, ice, or electrical stimulation if you have swelling or pain. Your therapist may also use hands-on stretching and show you exercises to improve knee range of motion. Strength exercises target the major muscle groups, including the buttock, hip, thigh, and calf muscles. Endurance can be achieved by stationary cycling, swimming, and using an upper body ergometer (upper cycle).
Therapists sometimes treat their patients in a pool. Exercising in a pool puts less pressure on the knee joint, and buoyancy allows you to move and exercise more easily. Once you have completed your pool exercises and other parts of your rehabilitation program are progressing, you may follow an independent program.
When you are confident about putting full weight on the leg, several types of balance exercises can be chosen to further stabilize and control the knee.
Finally, a select group of exercises can be used to simulate daily activities, such as going up and down stairs, squatting, rising on your toes, and bending. Specific exercises can then be chosen to simulate the demands of your work or hobbies.
Many patients have less pain and better mobility after a tibial osteotomy procedure. Your therapist will work with you to help keep your knee joint healthy for as long as possible. This may require you to adjust your activity choices to avoid putting too much pressure on your knee.
The therapist's goal is to help you improve knee range of motion, maximize strength, and improve your ability to do your activities. When you are well under way, regular visits to the therapist's office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.