Understanding knee realignment surgery

One of the most common causes of pain, discomfort or stiffness in the knee joint is a type of arthritis known as osteoarthritis. In severe cases of osteoarthritis, the alignment of the knee joint may be affected.

Should the joint become significantly misaligned, your consultant may recommend knee realignment surgery is carried out in order to correct the problem and to avoid any further changes occurring.

How does osteoarthritis affect the knee joint?

Osteoarthritis is the most common type of arthritis in the UK and can affect people of all ages, although it is more commonly seen in adults over 40.

The bones in your knee have a lining of cartilage, known as ‘articular cartilage’, at their ends which helps them to move freely and smoothly over one other. Osteoarthritis causes this cartilage to wear down, leading to pain and stiffness in the knee as the bones rub or ‘grate’ more against each other due to the uneven surfaces.

Damage to the articular cartilage in the joint leads to a greater load being placed onto the tendons, ligaments and muscles of the knee, and this can cause swelling and the formation of small bony spurs, known as osteophytes.

In extreme cases, damage to the cartilage in your knees may be so significant it permanently alters the shape of the joint. Should this occur, your doctor may advise you to have knee realignment surgery (also sometimes referred to as ‘knee osteotomy surgery’ or ‘knee realignment osteotomy’).

When the cartilage wears out at roughly the same rate throughout the knee joint, the symmetry of the joint is usually maintained. If the cartilage on one side of the knee is affected more than the other side, the joint space may narrow unevenly, causing the leg to deform from its regular shape.

Knee realignment surgery is a way of correcting this misalignment.   

An ‘osteotomy’ refers to the cutting of a bone. Where your knee joint has been structurally altered due to damage caused by osteoarthritis, a specialist knee doctor (known as an orthopaedic surgeon) may carry out an osteotomy on the affected bone in order to correct the position.

Knee realignment surgery is normally carried out under general anaesthetic, meaning you will not be conscious during the surgery. An anaesthetist will talk with you about the anaesthetic they will be using for the procedure, and if you have any queries at any time, they will be happy to help.

Before your surgery, the surgeon will have carefully planned the procedure, using X-rays and/or imaging from other diagnostic scans to precisely calculate the angle of any corrections needed to realign the joint.

Once you have been given the general anaesthetic, the skin around your knee will be thoroughly cleaned using an antibacterial fluid. The surgeon will make an incision in the skin in order to gain access to the knee joint and then use a special surgical to cut away the precise area of bone required, or to remove a small ‘wedge’ of bone which they will then use as a bone graft in the joint.

The surgeon will check the new alignment of the knee joint, making small adjustments if required to ensure optimal positioning. They may then use a combination of surgical plates and screws to securely fix everything in place, before closing the incision made during the surgery with stitches or special surgical tape. Your knee will then be covered with a sterile dressing to ensure it remains free of infection.

Following your surgery, you will be taken to the recovery room, where out theatre staff will monitor you carefully while you wake up from the anaesthetic. Once you have fully woken up and the theatre recovery room staff are happy with your blood pressure, heart rate and oxygen levels, you will be taken back to your ward to rest.

Knee realignment surgery is a significant procedure and it will take you time to fully recover from it. While you are recovering, it is important to take things slowly in order to gain maximum benefit from the surgery, and you will be supported in this by the multidisciplinary healthcare team in the Knee Clinic.

All surgical procedures carry risks and the potential for complications. For knee realignment surgery, these include:

  • Infection in the knee joint,
  • Damage to the nerves near the knee joint,
  • Failure of the bones to heal sufficiently,
  • Formation of a blood clot (known as a ‘deep vein thrombosis’ or ‘DVT’).

The above risks are intended as guidelines only and are not exhaustive. We always recommend that you talk with your consultant about potential risks and complications before you decide to have any surgery.

The consultant-led orthopaedic Knee Clinic at St Joseph’s has vast experience in carrying out knee realignment surgery. Should you be experiencing pain and/or a change in shape of your knee joint, please contact us to arrange a consultation with one of our knee specialists. They will assess the cause of your pain and determine the best treatment option available for you.

Should knee realignment surgery be advised, the expert team in our Knee Unit will make sure you receive the best treatment and post-operative support possible.

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