In recent years, the incidence of knee osteoarthritis (OA) in individuals below the age of 60 has been increasing. Specifically, OA can be induced or aggravated by knee malalignment. The most common form of knee malalignment is “genu varum” or “bow-leggedness”. The other form is known as “genu valgum” or “knock-knees”. Malalignment causes overloading of one compartment iof the knee. For example, in genu varum the medial or “inner” compartment of the knee gets overloaded and with or without additional injury to the cartilage or meniscus of the knee, medial compartment OA can develop. Similarly, in genu valgum, lateral or “outer” compartment OA can develop.
A joint preserving osteotomy does not replace the joint. Instead, either or both of the thigh (femur) and shin (tibia) bones are cut and the limb is realigned so that the leg is straightened. This allows the body weight to be distributed evenly through the knee joint. Therefore, the pressure on the already damaged cartilage in the knee is relieved and this allows some healing capacity in the long-term.
Figure 2: An example of a joint preserving osteotomy performed over the right knee of a patient with a varus knee OA using a minimally invasive approach with small implants. Note how the weight bearing line has been moved away from the inner compartment to allow for the damaged cartilage to heal.
Advantages of Joint Preserving Osteotomy
While joint replacement surgery may be an excellent option for older patients with end-stage arthritis, young active patients do not do as well. In younger patients with active lifestyles, joint preserving osteotomy can delay or obviate the need for joint replacement surgery. The key advantages for joint preserving osteotomy include:
Although there is no known cure for OA, treatment designed for the individual patient can reduce pain, improve joint mobility and limit functional impairment. The management of OA includes both conservative and surgical options. Conservative options are further divided into pharmacological (medication) and nonpharmacological modalities. Surgical options include various types of osteotomy, arthroscopic interventions and knee arthroplasty, of which total knee arthroplasty (TKA) is the most commonly performed. As the burden of knee OA keeps increasing, the number of TKAs performed is reported to be increasing every year.1 However, variation in postoperative outcomes has been observed among patients, with up to twenty percent of patients dissatisfied with their outcomes after TKA.3 Traditionally, OA is thought to be a progressive disease of the adult and elderly. However, we are seeing symptomatic OA in younger population groups today. Over half of all persons with symptomatic knee OA are younger than 65 years of age.3 As many of these younger persons will live for three decades or more, there is substantially more time for greater disability to occur. There is therefore a need for deployment of innovative prevention and treatment strategies for knee OA.
Recovery timeline
While this depends on the individual patient, most patients are able to put some weight on the operated leg immediately following surgery. However, full rehabilitation takes between 6 to 12 weeks. Most patients are able to return to work 6 to 8 weeks following surgery and perform some light activity from 8 to 12 weeks.
The Joint Preserving Osteotomy Service (JPOS) in SKH is led by Assoc Prof Hamid Razak [hyperlink to my profile page]. Assoc Prof Hamid Razak underwent fellowship training in joint preservation surgery with Prof Adrian Wilson, a global leader and an expert in the field of knee osteotomy surgery. Assoc Prof Hamid Razak utilizes computer-assisted planning as well as a minimally invasive soft-tissue sparing approach with smaller, stronger implants from Europe. This allows patients to recover quicker compared to traditional approaches. Advanced deformity correction may also necessitate patient-specific instrumentation (PSI) where cutting guides are 3D-printed tailored to the anatomy of the bones which reduces surgical time and increases precision of surgery. Assoc Prof Hamid and his team are also heavily invested in research and innovation in joint preservation surgery.
References
Medical professionals who would like more information about this procedure, please contact Assoc Prof Hamid Razak at hamid.razak@singhealth.com.sg.
GPs can call for appointments through the general appointments hotline at 6930 6000.
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