Osteotomy is a surgical procedure where the bones of the leg are shifted to alter the alignment of the knee. This is most commonly done for localised arthritis of the knee joint, particularly for younger or more active patients where we’d like to avoid a knee replacement for some time. In realigning the knee, we shift the load on the knee from the damaged portion to the healthier portion of the knee. Less commonly, the procedure is used to aid in ligament stabilisation of the knee, or for patients with cartilage or meniscal deficiency.
X-ray taken before osteotomy
Intra-operative view and X-ray after High Tibial Osteotomy
Intra-operative view and X-ray after Distal Femoral Osteotomy
In most cases you should continue with any regular prescribed medications in the lead up to your surgery. I need to know your medical history to plan the best treatment for you in hospital. Particularly, please let me know if you:
You will be admitted on the day of surgery. My team will provide you with the admission time and fasting details.
Most patients are discharged from hospital after a 1- or 2-night stay. During your hospital stay, the focus will be on keeping you comfortable and commencing the first phases of rehabilitation. You will be seen post-operatively by myself, the physiotherapists and nursing staff who all have a role in your care.
First 2 Weeks
The priorities for recovery in the first two weeks after osteotomy are:
There will be some heavier bandages wrapped around your knee which are generally taken down the day after your surgery. Overlying the surgical incision is an adhesive dressing, which if clean and dry can just be left in place. The nursing staff in hospital will help you with any questions you have regarding your dressings, and I will check the healing of your wound at our follow-up appointment approximately 2 weeks after surgery.
I use a number of different modalities to help with pain relief, and your anaesthetist will talk you through these. In general, regular paracetamol and an anti-inflammatory (if tolerated) are the mainstays of pain relief. You will be given some stronger medications which can be helpful in the early post-operative period, but these can be phased out as your comfort level increases.
The exact time until you return to driving is variable depending on your recovery and the leg you had operated on. It’s sensible to allow at least two weeks to return to driving. For some patients return to driving may be longer.
This will vary depending on the nature of work you do. At a minimum, you should have at least 2 weeks away from work to allow the incision to heal and your pain levels to reduce. Office-based workers may plan to return to work at this stage, although those doing heavy manual labour may require 6-12 weeks away from work.
A physiotherapist will visit you twice per day whilst in hospital, but it is important to perform exercises and activities on your own to enhance your recovery. Once discharged, I recommend you see a physiotherapist on a regular basis until you have recovered to a satisfactory level. I can help you with some advice on appropriate physiotherapists if you do not already have one.
Superficial infection is not very common but can happen. It usually presents as redness and increased pain around the wound, and generally resolves with a short course of antibiotics.
Deep knee infection is rare. If it does happen you will need admission to hospital, with washing out of the incision and high dose intravenous antibiotics commenced as soon as possible. Symptoms of deep infection include increasing knee pain, swelling, redness and fever.
If you are concerned about an infection, please contact me as soon as possible. During business hours the best point of contact is via my assistant on 08 9212 4292. After hours, please contact the hospital where you had your surgery, and ask them to get in touch with me. Failing this, present to your local Emergency Department for review.
Poor Bone Healing
Rarely, the bone does not heal as quickly as expected after it has been realigned. Occasionally, revision surgery may be required to stimulate bone healing.
It is not uncommon to get some numbness over the front of the knee. This is usually noticed post operatively, and often gets less noticeable as time progresses. Occasionally it can persist, but is usually very well tolerated.
Foot and Ankle Swelling
This is normal to an extent, and generally reflects the effects of gravity on the swelling around your knee. If you get excessive foot and ankle swelling, remove your tubi-grip bandage, elevate your leg above your body and ice your knee.
Blood clots can form in the deep veins of the calf or leg, or occasionally these clots can travel to your lungs (pulmonary embolus), affecting your breathing. During your inpatient stay I use blood thinners to help prevent clots from forming, although there is no method that is 100% effective. In the event you do have a large clot in your legs (DVT) or in your lungs, you will need to go on to longer term blood thinning medication until it has resolved.
This is very rare, but there have been instances of damage to the bones, arteries, nerves and veins in the leg. Some of these require repair during surgery, and other instances will improve with time.
My assistant will provide you with a quote prior to surgery, outlining any costs not covered by Medicare or your health fund.
Dr Radic is a No Gap Provider for NIB and HBF, and has agreed gaps for other insurers.
If you have an issue with your knee, make an appointment with Dr Radic to discuss your treatment options.
For all appointments and enquiries, please contact us on:
Alternatively, please call the switchboard on 08 9212 4200 and ask for Dr Radic's rooms.
Perth Orthopaedic & Sports Medicine Centre
31 Outram Street
West Perth WA 6005
4 Antony Healthcare
4 Antony Street
Palmyra WA 6157
100 Stephenson Ave
Mount Claremont WA 6010
36 Frederick St
Djugun WA 6725