Can high tibial osteotomy save from knee replacement surgery?

Tibial osteotomy is a surgical procedure that aims to change the center of gravity of the leg and take less load on the damaged parts.

It is a useful procedure when the pain associated with calcification of the knee is worn and eroded, especially on one side of the patient (typically the inner side).

The aim is to shift the patient’s body weight from the damaged area to the other side of the knee where the cartilage is still healthy. This is achieved by changing the direction of the leg by 8-12 degrees with a filling process on the upper part of the leg. Mostly, osteoarthritis of the knee occurs on the inside of the knee. In our patients, body weight is loaded on the inside of the knee. In this process, we shift this weight from the inner part of the damaged knee to the outer part of the healthy knee, so we see a dramatic reduction in pain and reduction in the wear process.

The idea behind this is that osteoarthritis may be due to or result in deformity of the knee. If the inner side is affected, this can result in varus malalignment, i.e. inward-bent knees.

Tibial osteotomy is an alternative to knee replacement surgery (knee arthroplasty), especially for young osteoarthritic patients who want to continue an active lifestyle. The most important advantage is that the restrictions recommended after knee replacement surgery are not available after this surgery. Because this is a joint-preserving surgery and aims to protect what already belongs to you.

Knee replacement surgery, however well performed, is not designed for the rigors of working life or young active sports life. Osteotomy can also be considered as a salvage operation to avoid total knee replacement. The progression of calcification can be slowed down or completely eliminated by performing osteotomy in a calcification detected in the beginning and mid-term.

After a tibial osteotomy, a patient can expect significant relief from pain and disability. However, a salvage procedure performed on a damaged knee may not always provide 100% pain relief due to the nature of the disease. In a very low rate, it may require knee replacement surgery in the future.

The two most important factors contributing to the success of tibial osteotomy are the weight of the patient and the angular correction of the surgery. If the two are ideal, about 70% of results should not require major surgery over the next 10 years.

There are potential complications associated with osteotomy surgery. However, the complication rate is lower than that of knee replacement. More importantly, while the complications of knee prosthesis are very difficult and long to correct, the complications to be experienced here can be resolved much easier and faster.

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