High tibial osteotomy is a complex knee procedure performed in patients that need a realignment of the knee articulation. It is often performed in patients with knee osteoarthritis or another type of arthritis in the knee to reduce the rate of wear down of the articulation. That way, we will prevent or delay significantly the need for a total or partial knee replacement surgery, which is even more complicated. This surgery’s success rate is very high, around 91% for the first 5 years and 80% after 10 years. But what factors can influence this success rate? How can you and your doctor make sure that the procedure goes as expected?
What factors influence the success rate in high tibial osteotomy?
There is a number of factors that influence the success rate in this type of procedure. Knowing this, doctors do not recommend this type of surgery for every patient. When they do, they prepare patients for the procedure and give precise recommendations to increase the success rate. It is essential to follow their guidance to have a better outcome. Here’s a list of factors that influence your success rate:
- The patient’s age: This factor is very important due to a series of bone tissue changes as we age. Thus, not all patients and ages are appropriate for high tibial osteotomy. The success rate is higher in younger patients who are physically more active, and the usual age is between 40 and 60 years.
- Overweight and obesity: Your current weight is another factor that affects the success rate in this type of surgery. The patient should not be obese, not even overweight. This would affect the outcomes due to an increase in the pressure of the articulation after the procedure. Thus, losing weight is often recommended as a preliminary step to planning for surgery.
- An accurate diagnosis: It may seem trivial because we all assume that a diagnosis is correctly made. But if there’s a trace of doubt, it is better to be entirely sure about the diagnosis. Otherwise, a high tibial osteotomy will do nothing to improve pain symptoms. That’s why doctors need to test mobility in the patient, ask them to straighten the knee, bend it to 90 degrees or more, and make sure the condition affects only one side of the knee.
- Trying with a leg brace to make sure: When patients and their doctors want to make sure how it will feel after surgery in advance, they can use a leg brace that mimics the articulation’s alignment that is intended with high tibial osteotomy. This previous step before surgery can help patients evaluate how they will feel after osteotomy and if there will be any benefit from it.
- Physical therapy after surgery: When the procedure is done, the patient won’t initially feel the change. The job is only partially done, and physical therapy after high tibial osteotomy does the trick to increase the success rate. It is imperative for patients to strictly follow physical therapy if they want a better outcome. In some cases, doctors may also recommend physical therapy as preparation before surgery. It aims to increase the range of motion of the knee, and it also increases the chance of success as long as patients stick to the therapy plan.
What should I do before surgery?
It is essential to highlight a few recommendations if you’re a candidate for a high tibial osteotomy. First off, following the instructions left by your doctor is a fundamental step to increase your success rate. As noted above, there are some preparation steps that you may need to fulfill before surgery. But in your day-to-day, there are also a few modifications you need to adopt two weeks before the procedure:
- You need to stop taking ibuprofen and aspirin. These medications slow down the clotting process in the blood and make you prone to bleeding. Ask your doctor what pain medications are better to handle your symptoms.
- Steroid medications are also inappropriate in this step of the process. You need to stop taking them 2 weeks before surgery because they cause a mild suppression of the immune system that increases your chance of infection after surgery. Once again, if you use steroid medication to control your symptoms, you need to talk to your doctor to find a suitable alternative
- Do not smoke for two weeks. The effects of nicotine in your body tissues are not appropriate for surgery and may slow down your healing process. Moreover, if you smoke, you get a higher chance of developing blood clots in your veins and a potentially deadly case of deep vein thrombosis after surgery.
In this case, your doctor will give you recommendations, and you need to follow them precisely as they are laid down. These instructions can further increase your success rate by reducing the complications during and after surgery.
Preparation for surgery
As a part of your surgery preparation, the doctor may also need to verify a few things to evaluate if you’re a suitable candidate. You need medical clearance and may require blood exams and imaging tests to assess your heart health, your respiratory health, and the functional capacity of your blood.
If you have diabetes or heart disease, it is important to talk to your doctor about it. You may need further studies to ensure that anesthesia will do the job as intended and without any complications to your cardiovascular health.
References:
Amendola, A., & Bonasia, D. E. (2010). Results of high tibial osteotomy: review of the literature. International orthopaedics, 34(2), 155-160.
Tang, W. C., & Henderson, I. J. (2005). High tibial osteotomy: long term survival analysis and patients’ perspective. The knee, 12(6), 410-413.
Hassenpflug, J., von Haugwitz, A., & Hahne, H. J. (1998). Long-term results of tibial head osteotomy. Zeitschrift fur Orthopadie und ihre Grenzgebiete, 136(2), 154-161.
Flecher, X., Parratte, S., Aubaniac, J. M., & Argenson, J. N. A. (2006). A 12-28-year followup study of closing wedge high tibial osteotomy. Clinical Orthopaedics and Related Research®, 452, 91-96.
