Preparing for Surgery
The decisions you make and the actions you take
before your surgery can be every bit as important as the
procedure itself in ensuring a healthy recovery. Getting
a second opinion from a surgeon who is as qualified as
the surgeon who gave the initial diagnosis is usually
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
surgery, notify your physician of any physical problems
you have been experiencing, such as a fever or infection.
You should also notify your surgeon of any medication
you are taking.
walking with your crutches in case you need to use them
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will go to "patient
admissions" to check in for your outpatient arthroscopic
surgery. After you have checked in to the hospital or
clinic, you will go to a holding area where the final
preparations are made. The paperwork is completed and
your knee area may be shaved (this is not always necessary).
You will wear a hospital gown and remove all of your
jewelry. You will meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of shorts or sweatpants that will fit comfortably
over your knee bandage when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
Depending on where osteoarthritis has damaged your
cartilage, an osteotomy removes a wedge of bone from
different areas of your shinbone. The most common type
of osteotomy performed on arthritic knees is a high
tibial osteotomy, which addresses cartilage damage on
the inside (medial) portion of your knee. The following
surgery section provides details about the high tibial
osteotomy procedure that apply in general to most other
osteotomy procedures. The procedure usually takes one
to one-and-a-half hours to perform. During a high tibial
osteotomy, surgeons remove a wedge of bone from the
outside of your knee, which causes your leg to bend
slightly inward. It is like realigning a bowlegged knee
to a knock-kneed position. Your weight is transferred
to the outside (lateral) portion of your knee where
the cartilage is still healthy.
anesthesia is administered, which may be regional, or
general, the surgical team sterilizes the leg with antibacterial
to three small, four-millimeter incisions may be used
for the diagnostic portion of the operation. Surgeons
can take a close look at your knee with the aid of an
arthroscope (a tiny camera about 3.5 millimeters in
map out the exact size of the bone wedge they will remove,
either using an X-ray, CT scan, or 3D computer modeling.
large, four- to five-inch incision is made down the
front and outside of your knee, starting below the kneecap
and extending below the top of your shinbone.
wires are drilled into the top of your shinbone (tibia
plateau) from the outside (lateral side) of your knee.
The wires usually outline a triangle form in your shinbone.
standard oscillating saw is run along the guide wires,
removing most of the bone wedge from underneath the
outside of your knee, below the healthy cartilage. The
cartilage surface on the top of the outside (lateral
side) of your shinbone is left intact.
usually refine the exposed shinbone surface with chisels
until it is smooth.
top of your shinbone is then lowered on the outside
and attached with surgical staples or screws, depending
on the size of the wedge that was removed.
layers of tissue in your knee are stitched together,
usually with absorbable sutures.
Following a knee osteotomy, you usually stay in the
recovery room for at least two hours while the anesthetic
wears off. This procedure typically causes severe pain.
You will be given adequate pain medicine, either orally
or through an IV (intravenous) line, as well as instructions
for what to do over the next couple of days. Your knee
will be bandaged and may have ice on it. You may have
significant pain early on and you should take the pain
medicine as directed. Remember that it is easier to
keep pain suppressed than it is to treat pain once it
becomes present, so ask the nurse for medication when
you feel pain coming on. You should try to move your
feet and ankles while you are in the recovery room to
improve circulation. Your temperature, blood pressure,
and heart rate will be monitored by a nurse, who, with
the assistance of the doctor, will determine when you
are ready to leave the hospital or, if necessary, be
admitted for an overnight stay. Most patients remain
in the hospital for three to six days following an osteotomy.
After knee osteotomy, you usually are taken to a hospital
room where nurses, anesthesiologists, and physicians
can regularly monitor your recovery. Most patients spend
three to six days recovering in the hospital. As soon
as possible after surgery is completed, you will begin
doing continuous passive motion exercises while in bed.
Your leg will be flexed and extended to keep the knee
joint from becoming stiff. This may be done using a
continuous passive motion (CPM) machine. The CPM is
attached to your bed and then your leg is placed in
it. When turned on, it takes your leg through a continuous
range of motion. There will likely be pain, and you
can expect to be given pain medication as needed. Ice
also helps control pain and swelling. For two or three
days after surgery, you may experience night sweats
and a fever of up to 101. Your physician may suggest
acetaminophen, coughing, and deep breathing to get over
this. This is common and should not alarm you. The incision
usually starts to close within six days and the bandage
can be removed. Physicians commonly fit you with a hinged
knee brace that allows a limited range of movement and
helps push your knee into the correct position. For
a high tibial osteotomy, the hinged knee brace pushes
your knee inward, making you slightly more knock-kneed.
You may be able to put some weight on your knee, but
physicians usually prescribe crutches for at least six
weeks. You will be given a prescription for pain medication
and usually schedule a follow-up visit sometime around
six weeks after surgery.
You will likely feel pain or discomfort for the first
week at home after an osteotomy, and you will be given
a combination of pain medications as needed. A prescription-strength
painkiller is usually prescribed and should be taken
as directed on the bottle. Swelling in your leg usually
decreases over a span of three to six months after surgery.
There may be some minor bleeding for a few days, but
by the time you are released from the hospital, most
bleeding should have stopped. If you notice an increase
in swelling or bleeding, you should call your physician.
Physicians generally recommend that you avoid putting
stress on your knee until the bones have healed. Putting
weight on your knee too early may damage the bone surface
and prolong healing time. Here is what you can expect
and how you can cope after an osteotomy:
your knee for 20 or 30 minutes a few times a day during
the first week after an osteotomy will help reduce pain.
Ice therapy may need to intermittently continue for
a few months if pain bothers you.
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle.
your knee in the prescribed, hinged knee brace for about
six weeks. You may remove the brace for brief periods
to perform passive motion exercises with the aid of
a physical therapist or a CPM machine. Range of motion
exercises are important for healing. Regaining full
extension is just as important as bending your knee.
leg may appear slightly bent after the surgery as it
heals into its new alignment.
patients have to keep the incision dry for seven to
ten days. Your physician can recommend a surgical supply
store that sells plastic shower bags. Wait until you
can stand comfortably for 10 or 15 minutes at a time
before you take a shower.
or a cane may be needed for between six and ten weeks,
depending on the pain. It is difficult to describe the
amount of pain any given patient will experience.
weeks after surgery, your physician usually gives you
a check-up. X-rays can determine how your bones are
healing and whether you are ready to begin rehabilitation.
may have to take between six weeks and six months off
from work, depending on how much you rely on your knee
to perform your job.
to call the doctor after surgery
Most patients can begin physical therapy around six
to eight weeks after surgery. Unlike other surgical
treatments for arthritis, osteotomy relies on bone healing
before more vigorous, weight bearing exercises in the
gym can begin. In the best scenario, people respond
to strengthening exercises and stop wearing the brace
after the first three to six months of therapy. Light
exercise is one of the most effective ways to relieve
arthritis pain by stimulating circulation and strengthening
the muscles, ligaments, and tendons around your knee.
Strong muscles take pressure off the bones so there
is less grinding in the knee joint during activities.
In conjunction with a healthy diet, exercise can also
help you lose weight, which takes stress off your arthritic
In the first few weeks of rehabilitation, your physical
therapist usually helps you stretch the muscles in the
hamstrings, quadriceps, and calves while flexing and
extending your knee to restore a full, pain-free range
When pain has decreased, physicians generally recommend
at least 30 minutes a day of low-impact exercise a day
for patients with arthritis. You should try to cut back
on activities that put a pounding on your knees, like
running and strenuous weight lifting. Cross-training
exercise programs are commonly prescribed when you have
arthritis. Depending on your preferences, your workouts
may vary each day between cycling, cross-country skiing
machines, elliptical training machines, swimming, and
other low-impact cardiovascular exercises. Walking is
usually better for arthritic knees than running, and
many patients prefer swimming in a warm pool, which
takes your body weight off your knees and makes movement
Strength training usually focuses on moving light weights
through a complete, controlled range of motion. You
should generally avoid trying to lift as much as possible
with your quadriceps and hamstrings. Your physical therapist
typically teaches you to move slowly through the entire
movement, like bending and straightening your knee,
with enough resistance to work your muscles without
stressing the bones in your knee. Once your physical
therapist has taught you a proper exercise program,
it is important to find time each day to perform the
strengthening exercises: Cartilage injuries
After rehabilitation, preventing osteoarthritis is
a process of slowing the progression and spread of the
disease. Because patients remain at risk for continued
pain in their knees after treatment, it is important
they are proactive about managing their conditions.
A fall or torque to the leg during the first two months
after surgery may jeopardize the healing of your bones.
You should exercise extreme caution during all activities,
including walking, until your physician determines that
your bones have healed. Maintaining aerobic cardiovascular
fitness has been an effective method for preventing
the progression of osteoarthritis. Light, daily exercise
is much better for an arthritic knee than occasional,
heavy exercise. When you have arthritis in your knees,
it is especially important to avoid suffering any serious
knee injuries, like torn ligaments or fractured bones,
because arthritis can complicate knee injury treatment.
You should avoid high-impact or repetitive stress sports,
like football and distance running, that commonly cause
severe knee injuries. Depending on the severity of your
arthritis, your physician may also recommend limiting
your participation in sports that involve sprinting,
twisting, or jumping. Because osteoarthritis has multiple
causes and may be related to genetic factors, no simple
prevention tactic will help everyone avoid increased
arthritic pain. To prevent the spread of arthritis,
physicians generally recommend that you take the following
anything that makes pain last for over an hour or two.
controlled range of motion activities that do not overload
heavy impact on the knees during everyday and athletic
strengthen the muscles in your thigh and lower leg to
help protect the bones and cartilage in your knee.
Non-contact activities are a great way to keeping joints
and bones healthy and maintain fitness over time. Exercise
also helps promote weight loss, which can take stress
off your knees.
| Treatment Introduction
Knee osteotomy is commonly used to realign your knee
structure if you have arthritic damage on only one side
of your knee. The goal is to shift your body weight
off the damaged area to the other side of your knee,
where the cartilage is still healthy. When surgeons
remove a wedge of your shinbone from underneath the
healthy side of your knee, the shinbone and thighbone
can bend away from the damaged cartilage. Imagine the
hinges on a door. When the door is shut, the hinges
are flush against the wall. As the door swings open,
one side of the door remains pressed against the wall
as space opens up on the other side. Removing just a
small wedge of bone can "swing" your knee
open, pressing the healthy tissue together as space
opens up between the thighbone and shinbone on the damaged
side so that the arthritic surfaces do not rub against
each other. Osteotomy is also used as an alternative
treatment to total knee replacement in younger and active
patients. Because prosthetic knees may wear out over
time, an osteotomy procedure can enable younger, active
osteoarthritis patients to continue using the healthy
portion of their knee. The procedure can delay the need
for a total knee replacement for up to ten years.