Osteotomy

Microfractures Partial Knee Replacement


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What is it and why?

  • A controlled fracture (osteotomy) to realign the bone and off-load the joint.

  • This can only be done in selected patients with single compartment arthritis.

  • Very few patients will qualify for this intervention and are usually reserved for young patients who are not ready for a more extensive replacement type surgery.


  • Treatment does not involve Home/self-help
    Home/self-help
  • Treatment involves Hospital
    Hospital
  • Treatment involves Daycase procedure
    Daycase procedure
  • Treatment involves Inpatient procedure
    Inpatient procedure
  • Treatment does not involve Local anaesthetic
    Local anaesthetic
  • Treatment involves General anaesthetic
    General anaesthetic
  • Treatment involves Regional block / Spina
    Regional block / Spina
  • Pain
    Pain

    Painful for 3+ months

  • Mobility
    Mobility

    Crutches 6+ weeks

  • Daily activities
    Daily activities

    Affected for 2+ weeks

  • Driving
    Driving

    No - 3+ months

  • Leisure activities
    Leisure activities

    Affected 6+ weeks

  • Light exercise
    Light exercise

    Affected 8+ weeks

  • Heavy exercise
    Heavy exercise

    Affected 3+ months

  • Light work
    Light work

    Affected 6+ weeks

  • Heavy work
    Heavy work

    Affected 4+ months

  • Intimate
    Intimate

    Affected 4+ weeks


Overview

What does it involve?

  • This is done under general anaesthetic as a day-case procedure.

  • It’s generally offered to patients with single compartment arthritis affecting the inner part of the joint (medial compartment arthritis).

  • A small wedge of bone is removed and then the bone is realigned so very little load goes through the area of the joint that is worn out.

Effort/burden

  • Very few patients qualify for this intervention.

  • You will need to remain non-weight bearing and use crutches for up to six weeks

  • You must accept the risks associated with a major operation

  • It can between three and six months to fully recover.

  • You may need to consider time away from work, difficulty in various daily activities and childcare-related issues.

  • You may need to undergo physiotherapy for a period of time after surgery.

Benefits

  • There is good evidence for performing such procedures in some selected groups of patients.

  • It is likely to delay the need for a full knee replacement.

Chances of cure

  • These measures will not cure arthritis.

  • However, it will transfer the load away from the worn-out joint and help ease the pain levels.

Limitations and side effects

  • All limitations and side effects after a major operation should be taken into account.

  • Scar sensitivity may limit some functions for months.

  • Knee pain may not completely diminish.

  • Pain might limit what you can do during a day.

  • Pain may get worse before it gets better, however, medication might help you with this.

  • There may be side effects from medications - especially painkillers and aesthetics (skin rash, constipation, liver or kidney damage). Please ask your doctor if you would like a full list of these possible side effects.

  • While you recover from the operation you may need to use physical aids such as crutches, boots or a plaster cast depending on the operation you have.

  • You will need to take care of the area that was operated on. This may mean using dressings and being careful with the surgical site.

  • You may need to visit your GP or hospital for follow up checks.

  • To get the most out of the surgery, you may need to visit a physiotherapist regularly.

  • These are likely to be affected after the operation:
    - Family life
    - Sleep
    - Intimate relationships
    - Leisure activities
    - Driving
    - Work

Risks

  • This procedure includes all risks associated with major operations.

  • This can include: pain, bleeding, swelling, stiffness, superficial infection or inflammation, sensitive scar, change in appearance of the operated area, numbness, incomplete symptom relief, deep infection needing further treatment, puckering of scar, keloid or thickened scar, recurrence of the problem, urinary tract problems (e.g. infection or retention), needing catheter, nerve damage, blood vessel damage, fractures, deep vein thrombosis (DVT), pulmonary embolus (PE) or complex pain.

  • General complications including heart problems (attack, irregular heartbeats), lung-related problems (pneumonia, lung collapse), post-operative delirium, postoperative decline in brain function, kidney failure, pressure sores, diathermy burns, wrong side surgery, severe allergy to medications, damage to structures unrelated to surgery, the regret of undergoing surgery, removal of the implant, arthrodesis - fusion of joint, amputation and death.

  • Specific complications such as improper realignment, failure of osteotomy to heal, damage to surrounding structures by implant or screws, need for further surgery to treat infections and fractures.

  • Some of the complications will need further treatment which may also include surgery.

  • The need for performing a joint replacement in the future is a possible risk, as it is not possible to determine how long the benefits from an osteotomy will last.

Cost

  • There are significant costs for both the patient and the NHS.

  • Patient: You will need to take time off work, require help during initial stages and visit the hospital, GP surgery and physiotherapist, which may cost in taxis and parking.

  • NHS: Generally a moderately expensive option, however, the cost of treatment can increase significantly should the need for treating complications arise.

What if no treatment is done?

  • Failing to treat your condition may result in ongoing pain and the need for the regular intake of medications.

  • Progression of the condition and subsequent health deterioration.

  • This may affect your social circumstances by intruding on your various activities of daily living (ADL), family life, working environment and leisure activities.

  • If the condition progresses further, complex and more demanding procedures might be required.

  • If it progresses significantly, no further treatment may be available.

  • Additional procedures may be needed to minimise inconvenience in the future.

  • The patient may feel regret for not choosing a surgical or other option at an earlier stage.


Microfractures Partial Knee Replacement