High Tibial Osteotomy : A Knee Preserving Surgery | Dr. Shreedhar Archik

Dr. Shreedhar Archik

All of us know about knee replacement surgery but no one knows about knee preservation surgeries! We orthopedic surgeons see a lot of young patients with knee pain. This pain starts after sports or gym activities or sometimes is noticed after a jerky movement. Typically, this pain does not settle with rest and analgesics. 
We then order an MRI and usually find the meniscus torn. A meniscus is a “C” shaped cushion that acts like a shock absorber in one’s knee. Knee Replacement Surgeon in Mumbai , Dr. Shreedhar Archik Explains more

The red arrow shows where we usually find the meniscus torn. The meniscus if torn at this site usually indicates that the person probably has bow legs.

This picture shows what the bow legs look like.
We then do a special x-ray called a sonogram. A scanogram looks something like this.

Scanogram is an x-ray which includes one’s hip-knee-ankle joints in one film. Normally a line drawn from the center of the hip goes through the center of the knee and center of the ankle. If you look carefully the x-ray above shows that the line on left does not even go through the knee joint at all!
If one’s body weight is distributed only on the inner side then obviously due to excessive weight the meniscus tears and if not treated the knee joints starts showing wear and tear very fast.
Normally a torn meniscus is stitched back by doing an arthroscopy i.e. minimally invasive surgery using a small telescope. But if the bow legs are not corrected then the repair will not last long.
So in such cases where there is a malalignment noted on scanogram we do another surgery in the same sitting called the ‘High Tibial Osteotomy”.
First, we use a special software to calculate exactly how much is the malalignment.

This picture shoes that this patient has 11 degrees of malalignment.
During the High tibial osteotomy we cut the bone just below the knee and restore the alignment to the last degree. We then use a plate to fix the broken bone.

The patient walks with the help; of a walker on the same evening and goes home in 2 to 3 days’ time.
Here is an x-ray to show the precise alignment achieved after surgery.

So, this is a blessing for all young patients who develop wear and tear of the knee early in life. They can preserve their own knee without going in for a replacement surgery.
In the picture below one can see the operated right leg looks very straight and the opposite looks bowed. This lady had bow legs on both sides and appreciated the correction post-surgery.

In short High tibial osteotomy is a knee preserving surgery for young arthritic patients.
And finally, is there anything one can do to prevent all of this? Though bow legs are something which you are born with here are a few tips to keep your knees in good shape.
  • Always use good quality footwear, especially use shoes rather than chappals.
  • If you are an exercise freak or a marathon runner always consult a qualified doctor if you start noticing any joint issues. 
  • Follow a good diet plan and always warm up and cool down before and after exercises.
Read more from Knee Replacement Surgeon in Mumbai , Dr. Shreedhar Archik
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