Joint Preservation Surgery
Osteoarthritis is notably one of the most debilitating forms of arthritis.
While joint replacement surgery has shown promising results for thousands of patients, it isn’t always the answer for all patients.
In recent years, joint preservation and joint restoration techniques have allowed individuals to put off joint replacement surgery. In general, these are performed in patients who may have more localised areas of arthritis or any other patients for whom a total joint arthroplasty may not be indicated because of their age or activity level.
Description of Join Preservation Surgery
The most joint preservation surgery is performed arthroscopically (key-hole surgery).
Localised areas of arthritis can be treated with microfracture / Autogenous Osteochondral Transfer (OATS) / Autologous Chondrocyte Implantation (ACI). These can be performed with or without a an osteotomy. All of these are considered to be “joint preservation operations”.
Patients who experience osteoarthritis often strive for ways to improve knee function, limit pain, and for many, put off knee replacement surgery. One surgery to postpone knee replacement surgery and improve function is a knee osteotomy.
A knee osteotomy is a surgical procedure that Mr Sethi performs on patients who have a single compartment of their knee affected by osteoarthritis. While this surgery for knee arthritis is usually effective for most patients, it is not a long-term fix for the problem. The significance of having the surgery is that for many patients, the procedure can offer years, and often a decade or more, of improvement and possibly continue to delay the need for knee replacement surgery.
Description of Knee Osteotomy
During a knee osteotomy, Mr Sethi will cut a wedge of bone to the upper shinbone (tibia) or lower thighbone (femur). In essence, this helps shift a body’s weight off the damaged area of the knee joint onto the more normal cartilage area on the opposite side of the knee.
During an osteotomy, Mr Sethi would use screws and plates, to hold the bones of the knee to their new aligned position and he may add bone graft to help the osteotomy heal faster. Most patients who undergo a knee osteotomy will stay in the hospital for 1-2 days for pain control and to initiate physical therapy.
Osteotomies of the knee have been validated to be effective for decreasing pain and improving patient movement in most instances.
Many people who undergo a knee osteotomy will eventually need a total knee replacement. However, research studies have reported knee replacements are more successful in patients over 60 years of age. Therefore, patients in their 30’s, 40’s and 50’s are ideal candidates for knee osteotomies.
A successful osteotomy depends on the ability of the cut bone surfaces to heal. We know that the bone of smokers have an impaired ability to heal. An osteotomy in a smoker can result in delayed healing or a total failure of the bone to heal. For this reason Mr Sethi will not perform an osteotomy in people who are currently smoking.
Patients are generally sent to physical therapy immediately after surgery to work on swelling control, muscle reactivation, and knee motion. In general, patients are on crutches for 4-6 weeks and progressively wean off crutches over the next month. This is achieved by slowly increasing weight bearing. A low impact exercise program to include walking, cycling, and aquatic therapy is progressed at this time. Most patients note significant improvement of their function by 4-6 months after the knee osteotomy.