Tibial-or-Femur-Osteotomies

Tibial and femur osteotomies, usually of valgization and varization respectively, are surgeries performed to correct lower limb axis deviations, commonly described as bent legs (knees in or out, also called, respectively, as genu valgus or varus).

The occurrence of these deformities lead to changes in the load distribution / “weight” at the knee joint level: internal compartment in the varus knee and external compartment in the valgus knee. This mechanical overload causes cartilage wear, which by definition corresponds to arthrosis associated with ruptured menisci. These tears are the most important and frequent factor in the pain experienced by the patient.

Seeking medical help is usually motivated by the onset of this acute pain, often without a trauma or effort to justify it. The degenerative process of intrarticular structures subjected to excessive mechanical loads facilitates their occurrence.

This surgery is most often indicated in physically active patients with moderate wear of a joint compartment (grade II to III arthrosis) and younger than 65 years.

The surgery consists of 2 surgical gestures: arthroscopic surgery to treat intrarticular lesions (menisci and cartilage) associated with open osteotomy. The latter consists of a planned bone cut of the femur or tibia in the direction of mechanical axis correction. They are performed at the same operative time, under local or regional anesthesia, depending on the decision of the patient and the anesthetist. Before surgery, you will have an Anesthesiology Consultation, for clarification on the anesthetic technique and preparation of the intervention.

The new bone position is maintained by placing fixation material in titanium or steel (usually titanium, allowing nuclear magnetic resonance), which will allow bone consolidation in the desired position. In this postoperative period, lower limb support may be limited or prohibited for reasons inherent to surgery or treatment of associated injuries (menisci or cartilage).

The surgical complications that may occur have a minimal incidence, the most frequent being infection, vascular or nerve damage, loss of reduction in the surgical positioning obtained and non-consolidation of the bone cut.

Once the osteotomy is consolidated, it may be necessary to remove the fixation material when it causes pain and functional limitation due to conflict with the soft tissues due to their anatomical location.

The advantage of this reconstructive surgery over a knee prosthesis is that it allows, if there is no advanced arthrosis already, the practice of impact sports, contraindicated in the prostheses. It can be a surgery of time commitment, lasting 5 to 15 years depending on the wear and tear, allowing a physically active life during those years. The success rate of this procedure is around 75% at 10 years. Performing this surgery does not preclude the possibility of performing a full knee prosthesis in the future.