Realignment surgery most commonly refers to high tibial osteotomy (HTO) and distal femoral osteotomy (DFO). HTO and DFO are surgical procedures performed to treat certain types of knee conditions, particularly those involving malalignment or early-stage arthritis. These procedures involve making controlled cuts in the bone to realign the knee joint and redistribute weight-bearing forces, thereby relieving pain and improving function.
During a high tibial osteotomy, a surgeon makes a carefully planned incision near the knee and cuts the upper part of the tibia (shinbone). The bone is then repositioned to correct the alignment of the knee joint, typically using metal plates, screws, or other fixation devices to hold it in place while it heals.
Similarly, in a distal femoral osteotomy, the surgeon makes an incision near the knee and cuts the lower part of the femur (thighbone). The bone is then realigned to improve the joint's mechanics and reduce stress on damaged areas.
Both procedures are typically performed under general anesthesia and may involve the use of imaging techniques such as X-rays or CT scans to ensure precise bone cuts and alignment.
Before the surgery, Dr Shales and his team will provide detailed instructions on how to prepare. This may include:
- Fasting for a certain period before the procedure.
- Adjusting medications, such as blood thinners, as directed by your surgeon.
- Arranging for transportation to and from the hospital.
- Preoperative evaluations, including blood tests and imaging studies.
It's essential to follow all preoperative instructions provided by your healthcare team to ensure a smooth surgical experience.
After the surgery, you will spend some time in the hospital for monitoring and initial recovery. Dr Shales and his team will provide pain management, assist with mobility, and monitor your progress closely.
Recovery timelines can vary, but generally, you can expect:
- Initial postoperative pain and swelling, which can be managed with medications and elevation of the leg.
- Gradual return to weight-bearing activities with the help of crutches or a walker.
- Physical therapy to regain strength, range of motion, and function of the knee joint.
Dr Shales will provide specific instructions for postoperative care and follow-up appointments.
Physiotherapy is a crucial component of rehabilitation following HTO or DFO surgery. A structured rehabilitation program will typically include exercises to improve strength, flexibility, and proprioception of the knee joint. Your physiotherapist will work closely with you to design a personalised rehabilitation plan tailored to your specific needs and goals.
As with any surgical procedure, there are potential risks and complications associated with HTO and DFO surgery. These may include:
- Infection
- Blood clots
- Nerve or blood vessel injury
- Delayed healing or nonunion of the bone
- Persistent pain or stiffness
- Under or Over-correction
Dr Shales will discuss these risks with you in detail before the surgery and take appropriate measures to minimise them.
The outcomes of HTO and DFO surgery can vary depending on factors such as the severity of the condition, the patient's overall health, and adherence to postoperative rehabilitation. However, many patients experience significant pain relief, improved function, and a delay or avoidance of more invasive procedures such as knee replacement surgery.
High tibial osteotomy and distal femoral osteotomy are effective surgical options for certain knee conditions, particularly those involving malalignment or early-stage arthritis. By realigning the knee joint and redistributing weight-bearing forces, these procedures can help alleviate pain, improve function, and delay the need for more extensive interventions.
Here are a number of the questions we often get asked.
The duration of HTO or DFO surgery varies depending on the complexity of the procedure but typically ranges from one to three hours.
Recovery timelines vary, but most patients can expect to return to light activities within a few weeks and resume more strenuous activities gradually over several months. Dr Shales will provide specific guidance based on your individual progress.
Success rates for HTO and DFO surgery vary but are generally high, particularly when performed on carefully selected patients with appropriate indications. Your surgeon can provide more specific information about the expected outcomes based on your individual situation.
