High Tibial Osteotomy
At Mater Health Services we understand that being in hospital can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients’ needs. It explains briefly the events that may occur during your visit and the things to expect when you are discharged from the hospital.
It is, however, only a guideline as each person may require differing treatments.
If you have any questions about your treatment please ask your doctor or nurse.
Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.
High tibial osteotomy
An osteotomy is an operation where a bone is cut and re-positioned. The “tibia” is the shin bone. In a high tibial osteotomy the bone of the upper tibia is cut and repositioned to realign the leg. This reduces the pain that you experience in your knee by taking pressure off the damaged joint surface.
A triangular wedge of bone is taken from the outer side of the tibia (the bone beneath the knee). This procedure does not return the knee to normal. However, it prolongs the life of a damaged knee, helps relieve pain in the knee and delays the need for a total knee replacement.
- You will have a curved scar about 10 centimetres in length along on the outside of your knee.
- Your leg may be shorter by up to one centimetre. This is unlikely to be noticeable.
- Your leg may appear to have a degree of ‘knocked knee’.
- The surgery is done to correct the alignment of the knee not to correct instability of the knee but this may also occur as a secondary benefit.
The two figures below show you before surgery (figure 4) and after surgery (figure 5).
Expected length of hospital stay
High Tibial Osteotomy has a hospital length of stay is approximately four days.
What are the risks involved with high tibial osteotomy surgery?
All patients are at risk of complications following surgery, but complications do not occur frequently. The following points are the main important complications to be aware of:
- Anaesthetic complications are extremely rare other than some postoperative dizziness and nausea.
- Pain: after surgery, your pain should be controlled using medication.
- Nerve and blood vessel damage: the surgical area is near a number of nerves and blood vessels. Injury to these nerves or vessels can occur (less than one in 300 patients).
- Swelling and numbness: due to the nature of the surgery there will be some swelling of the leg. This usually reduces over about two weeks. There will be an area of numbness next to the scar. You should be able to take your full weight on your leg but may require brace support for anything up to six weeks following surgery.
- Infection: this can be a serious complication but is usually picked up early and is easily treated. Repeated operations may be necessary to clean the infected tissue. High doses of antibiotics are usually given. Minor superficial infections can also occur which usually don’t cause much concern.
- Compartment syndrome: this needs to be identified early, when there is disproportionate pain and excessive swelling. An early return to theatre may be required to relieve the pressure build up in the leg.
- DVT: clots in the deep veins of the calf (deep vein thrombosis) can be serious. Some of the clot can break free and travel to the brain or the lungs. In severe cases it can even cause a stroke or it can be fatal if it blocks off a large segment of the lung. Blood thinning agents are given if there is a risk of DVT, and oral contraception should be stopped six weeks prior to this surgery as it does increase the risk slightly. Some measures are routinely taken to prevent clots, which will be discussed with you prior to surgery. The risk of anything serious happening is very low.
- Slippage or loosening of the plates and screws: although this is rare, adherence to the postoperative regime of limited weight-bearing and crutch usage limits this risk considerably.
- Non-union: this is when the bone fails to unite, although it is very rare, as the bone in this area has a good blood supply. If this does happen further procedures, including bone grafting, may be necessary.
Home visit by the DART occupational therapist
The DART occupational therapist may visit you in your home before your operation depending on your identified needs and where you live. This is to ensure that your home environment is optimal for when you return home. They will phone you to make an appointment at an appropriate time if necessary. The occupational therapist will have some suggestions about preparing your house for when you come home from the hospital to maximise your safety and independence.
After your operation
You will stay in the recovery room within the theatre suite after the operation while you wake up from the anaesthetic. You will be transferred on your bed to your room.
You will have a drip (IV). This is necessary to maintain your fluid intake. This will be removed when you are tolerating adequate amounts of oral fluids.
- You may be on antibiotics to help reduce the risk of infection. It is important to complete the full course of any antibiotic prescribed by your surgeon.
- You may also be on medication to reduce the risk of blood clots. This will be in the form of an injection and will be necessary to continue this treatment at home.
- Pain relief: you will have either a Patient Controlled Analgesia (PCA) or an epidural
- A PCA allows you to manage your own pain. PCA involves specialised equipment which is connected to a drip (IV). You will have a button to push which allows a small amount of pain relieving medication to be delivered directly into your vein via the drip. The equipment has a specialised safety program to reduce the risk of you receiving too much medication. You will remain on PCA until you are able to eat and drink. Your pain will then be managed with tablets. There is no risk of becoming addicted to strong pain relieving medication when it’s used appropriately.
- An epidural delivers pain-relieving medication into the space in your spine where the nerves carry pain signals from your operation site to your spinal cord and brain. The epidural usually remains in for one to two days depending on your type of surgery. Some patients will experience little or no pain with an epidural and may feel numb around the operation site. This is quite normal as this is its intended effect and means that the epidural is working, however if pain is moderate or severe you must notify your nurses immediately. You must also notify your nurses if you have any feeling of numbness or tingling around your mouth or upper limbs.
- If you have a PCA or epidural, you will more than likely be prescribed paracetamol (Panadol®) four times a day. Paracetamol works well when used on a regular basis and helps to reduce the amount of stronger pain-relieving medication you require which therefore reduces their side effects.
- You will be given oxygen via nasal prongs or a mask while you have the epidural or PCA in place. It is important to always keep this on when sleeping.
- While we try to relieve your pain as much as possible, some times it is not possible to take your pain away completely, however, your pain must be controlled well enough for you to move, complete your physiotherapy exercises and to sleep. If your pain relief is not adequately controlled for this please speak to your nurse. Also speak to your nurse if you have an itch, you feel nauseated or feel like vomiting. These may be side effects of the pain relieving medication and are usually easily managed.
Your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure etc), wound, drains and limb (colour, warmth, sensation and movement) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital.
About four hours after you return to the ward, your nurse will assist you to have a wash. Your drain will be removed anytime from 24 hours after your surgery when your doctor orders its removal. Your doctor may order special stockings to be worn to assist with the blood flow and reduce the risk of blood clot formation in your un-operated leg. These stockings are called TED stockings.
You will be resting in bed on the day of surgery.
The following exercises help prevent complications such as chest infections and blood clots in your legs. You should do these every hour that you are awake while resting in bed.
Breathing exercises: take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.
You will have a knee immobiliser in place at all times. The day following your surgery specific instructions and assistance will be given to you regarding weight-bearing by your physiotherapist. You are not usually allowed to take any weight through the operated side. Progression from non to partial weight-bearing with crutches will be recommended in most patients over a period of about six weeks. If you are not able to use crutches a walking frame may be required. While resting, it is important to keep your leg elevated to reduce swelling. Your physiotherapist will also discuss any exercises you are allowed to undertake. You will not usually be allowed to bend your knee until after you see the surgeon at clinic.
You will progress from clear fluids to light diet depending on what you can tolerate. You should be eating your usual diet by the time you leave the hospital.
You will be assisted with having a sponge or shower keeping your dressing and brace dry. You will be encouraged to manage your hygiene independently in preparation of going home. The TED stocking is removed prior to showering and replaced immediately after when dressing.
You will have a dressing on your wound and a brace applied to immobilise your knee joint.
The dressing and brace will remain in place throughout your hospitalisation. You may have a drain coming from your wound. This is usually removed after 24 hours.
The day you go home
Specific instructions will be given to you by your doctor, nursing staff and physiotherapist for when you go home.
- You should be independent with caring for your hygiene needs keeping your dressing and brace dry. If you are not completely independent with your hygiene cares, community nursing can be arranged to assist you three times per week.
- Your waterproof dressing will remain on until you see your surgeon at your post-operative appointment.
- Your brace will remain on for about six weeks postoperatively.
- If your doctor instructs, you will continue to wear your TED stocking on your un-operated leg until your activity level returns to normal.
- You will continue to take pain medication as required
- You may also be prescribed a blood thinner to continue for a prescribed period of time while your activity level is decreased.
- You will be ambulant with an aid and full instructions for safe use will be provided by your physiotherapist.
- You will be guided by your physiotherapist and your surgeon as to when you will be able to take weight through your operated leg.
Safe use of crutches
Crutches are required and your physiotherapist will instruct you on their use. If you are not able to use crutches a walking frame may be required.
Place your crutches forward and in a straight line, lean on your hands and your un-operated leg.
Non-weight bearing: with your crutches forward, lean on your hands and hop through, taking weight through your un-operated leg.
Partial weight bearing: your doctor will let you know when to start taking some weight through your operated leg and when to increase the weight gain.
When sitting: move backward to the chair until it can be felt by your un-operated leg. Slide the crutches out and hold them in one hand. Hold the arm of the chair with your other hand and gently sit. Place your operated leg on a stool when sitting to prevent swelling.
When using stairs
Never vary this sequence:
Going up the stairs: un-operated leg—operated leg and crutches
Going down the stairs: crutches—operated leg—un-operated leg
Please contact Mater Hospital Brisbane Emergency Department on 07 3163 8111 or your general practitioner (GP) if any of the following occur after discharge:
- your wound feels hot and tender
- unusual discharge from your wound and dressings or an odour from your dressing is present
- fever may be present or a general feeling of unwell.
- swelling is not reduced with elevation of leg
- a change is colour of your toes or coldness
- the calf muscle in your leg of the treated foot swells or is painful.
- your dressings are showing excessive amount of fresh blood.
- elevation and application of pressure dressings does not stop the bleeding
- the medication that has been prescribed for you is not helping control the pain while you have been resting with your limb elevated
- you are experiencing ill effects due to the medication that has been prescribed for pain, e.g. nausea, vomiting, gastric discomfort.
Notes: If you have any questions, please write them down and ensure that you have them answered before you go home.
Mater Hospital Brisbane
Raymond Terrace, South Brisbane Q 4101
Telephone: 07 3163 8111
Staff of Mater Hospital Brisbane, Raymond Terrace, South Brisbane, Qld 4101
© 2010 Mater Misericordiae Ltd. ACN 096 708 922.
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-420021
Last modified 16/11/2015.