Knee Osteotomy
Joint-Preserving Surgery for Younger, Active Patients
Comprehensive knee osteotomy surgery in Bowral, Goulburn and Campbelltown – helping patients with bow-legged or knock-kneed alignment, isolated arthritis and early joint damage preserve their natural knee for longer.
For many patients, knee arthritis is not spread evenly throughout the joint. Instead, it may affect only one side of the knee, often due to abnormal leg alignment. In these situations, a knee osteotomy may be a valuable alternative to knee replacement surgery.
An osteotomy is a procedure that changes the alignment of the leg to shift weight away from the damaged part of the knee. By redistributing pressure through the joint, osteotomy can reduce pain, improve function and delay the need for knee replacement.
Knee osteotomy is most commonly performed in younger, active patients who are not yet ideal candidates for knee replacement surgery. It is considered a joint-preserving procedure because it aims to keep the patient’s own knee for as long as possible. Dr Di Nallo takes a careful and conservative approach, ensuring patients understand all treatment options before surgery is considered.
Understanding Knee Alignment
The knee carries a significant amount of body weight during walking, stairs and exercise. If the leg is not properly aligned, extra pressure can be placed on one side of the knee joint.
The two most common alignment problems are:
- Bow-legged or varus alignment
- Knock-kneed or valgus alignment
In bow-legged patients, more weight is placed on the inner side of the knee. In knock-kneed patients, more pressure occurs on the outer side of the knee.
Over time, this uneven loading can lead to:
- Cartilage wear
- Arthritis
- Meniscus damage
- Pain
- Reduced function
- Progressive deformity
In some cases, correcting the alignment of the leg can significantly reduce pain and improve knee function without replacing the joint.
Who May Benefit from Osteotomy?
Osteotomy is generally considered for patients who:
- Are younger or middle-aged
- Have arthritis limited to one side of the knee
- Remain active
- Have bow-legged or knock-kneed alignment
- Want to delay knee replacement
- Have failed conservative treatment
- Still have good movement in the knee
- Have relatively healthy cartilage in the unaffected side of the joint
Osteotomy is often a particularly good option for active patients in their 40s and 50s who may be considered too young for knee replacement surgery.
Conditions Treated
Bow-Legged or Varus Alignment
Bow-legged alignment, also known as varus alignment, causes the knees to remain apart when standing with the feet together.
This places increased stress on the inner part of the knee joint and is commonly associated with:
- Medial compartment arthritis
- Meniscus wear
- Cartilage loss
- Knee pain
- Progressive deformity
A high tibial osteotomy is usually used to shift weight away from the damaged inner side of the knee.
Knock-Kneed or Valgus Alignment
Knock-kneed alignment, also known as valgus alignment, occurs when the knees angle inwards.
This increases pressure on the outer side of the knee and may contribute to:
- Lateral compartment arthritis
- Cartilage wear
- Instability
- Difficulty walking
- Pain with activity
In these cases, a distal femoral osteotomy is usually recommended.
Younger Patients with Isolated Arthritis
Many younger patients with arthritis affecting only one part of the knee are not ideal candidates for knee replacement because of their age and activity level.
An osteotomy can help delay the need for joint replacement by improving alignment and reducing pressure on the damaged area.
Conservative Treatment Before Surgery
Dr Di Nallo believes surgery should only be considered after a thorough trial of non-surgical treatment.
Conservative options may include:
- Physiotherapy
- Strengthening exercises
- Weight management
- Activity modification
- Anti-inflammatory medication
- Bracing
- PRP injections
- Cortisone / hyaluronic acid injections
- Orthotics
- Low-impact exercise
Some patients can manage symptoms for many years with these treatments. Surgery is generally only considered when pain and reduced function continue to affect quality of life.
Knee Osteotomy Procedures
High Tibial Osteotomy
What is a High Tibial Osteotomy?
A high tibial osteotomy is usually performed to correct bow-legged or varus alignment by changing the angle of the upper shin bone or tibia.
During the procedure, the tibia is cut and realigned so that weight is shifted away from the damaged inner side of the knee.
This can help:
- Reduce pain
- Slow the progression of arthritis
- Improve walking ability
- Delay knee replacement
- Preserve the natural knee joint
Who Is Suitable?
High tibial osteotomy is most commonly recommended for patients with:
- Bow-legged alignment
- Arthritis affecting the inner side of the knee
- Good knee movement
- Minimal arthritis in the rest of the joint
- Active lifestyle
Distal Femoral Osteotomy
What is a Distal Femoral Osteotomy?
A distal femoral osteotomy is usually used to correct knock-kneed alignment by changing the angle of the lower thigh bone or femur.
The aim is to reduce pressure on the outer side of the knee where arthritis or cartilage damage may be occurring.
Benefits of Distal Femoral Osteotomy
Potential benefits include:
- Reduced pain
- Improved alignment
- Better walking ability
- Delayed need for knee replacement
- Preservation of the natural joint
Combining Osteotomy with Other Procedures
In some patients, osteotomy may be combined with other knee procedures, including:
- Meniscus repair
- Cartilage reconstruction
- Ligament reconstruction
- Arthroscopy
This may be appropriate when there are multiple problems contributing to pain and instability.
Recovery After Knee Osteotomy
Recovery after osteotomy is generally slower than recovery after arthroscopy because the bone needs time to heal.
Patients may require:
- Crutches for several weeks
- A brace
- Physiotherapy
- Gradual return to walking
- Strengthening exercises
Most patients take several months to recover fully, although improvements in pain and function often continue over time.
What to Expect During Your Surgical Journey
Dr Di Nallo believes patients should feel informed, comfortable and supported throughout the entire process.
- Initial Consultation: Dr Di Nallo will assess your symptoms, examine the knee and review your imaging.
- Imaging & Planning: X-rays, MRI scans and long-leg alignment films may be used to assess the knee and plan surgery.
- Surgery: Osteotomy is performed in hospital under anaesthetic using modern fixation techniques to stabilise the bone while it heals.
- Rehabilitation: Physiotherapy plays an important role in restoring movement, strength and confidence after surgery.
Why Choose Dr Di Nallo for Knee Osteotomy Surgery?
Dr Di Nallo understands that many younger patients want to avoid or delay knee replacement surgery if possible.
He takes the time to carefully assess each patient and determine whether a joint-preserving procedure such as osteotomy may be appropriate. His approach is always conservative, thoughtful and focused on the least invasive treatment that will provide the best long-term outcome.
Whether you have bow-legged alignment, knock-kneed alignment or early arthritis affecting one side of the knee, Dr Di Nallo provides comprehensive osteotomy care for patients with a focus on quality clinical outcomes.
