Knee Osteotomy Surgery Cost and Procedure Information

What can knee osteotomy achieve?

Osteotomy is a type of surgery that removes part of a bone or bones to reshaped or realign them. It is usually done to adjust the weight distribution on the bone which can relieve symptoms such as pain and inflammation. It can be used throughout the body. This overview focuses on knee osteotomy.

Some of the most common conditions that lead to knee osteotomy are:

• Osteoarthritis
• Varus knees (known as being “bow-legged”)
• Knee issues in young, active people who may ‘wear out’ a knee replacement

Sometimes, osteotomy is performed on the knee to delay the need for a knee replacement. As the damage is likely to worsen with age, an early osteotomy may prevent the need for a full replacement knee for quite some time.

During the consultation, the surgeon will explain what knee osteotomy is and what to expect during and after the surgery.

Who Are BOA?

The BOA or British Orthopaedic Association, is the leading orthopaedic organisation in the UK. Members join training sessions to update themselves on the latest developments in orthopaedic diagnostics and treatment, meaning surgeons that join BOA are some of the top orthopaedic surgeons available in the UK.

How much does knee osteotomy surgery cost?

In the UK, the price of knee osteotomy surgery with a private care provider begins at around £5,000. The price is based on a number of factors, including pre-existing health conditions and the hospital’s location.

After the consultation, patients will be given a bespoke price for their tailored procedure. The personalised knee osteotomy surgery price will include:

• All fees related to your hospital stay
  • Accommodation (if needed)
  • Nursing care
  • Surgical theatre fees
  • Physiotherapy
  • Imaging costs
  • Medication
  • Pathology
• Aftercare
  • Seven days worth of any medications prescribed by your surgeon
  • A standard mobility aid like crutches or a cane
  • Ten post-operative physiotherapy sessions
  • One post-operative X-ray
  • Post-operative appointments with your surgeon

Your surgery price will not include:

• Diagnostic consultations
  • £245 for initial consultations
  • £150 for additional diagnostic consultations
• Diagnostic imaging scans
  • Estimated £150 per x-ray
  • From £240 for MRI scans

The knee osteotomy procedure

Before the procedure, patients will be asked to attend an appointment to assess their fitness for surgery. This will generally involve being asked some questions about health and any medications or supplements that are being taken.

Signing the consent form

On the day of the arthroscopy, the patient will meet with their surgeon. They will go over the details of the procedure again, make sure that the patient understands everything and that they are happy to go ahead and ask you to sign a consent form. This is a legal document that shows an understanding of the procedure and the potential risks and gives the surgeon consent to operate.

Anaesthetic

Once the consent form is signed, the anaesthetist will administer the anaesthetic. Depending on what was discussed previously, they will administer either general anaesthesia or a spinal block called an epidural. An epidural involves an injection into the spine that numbs the lower part of the body. Patients are often given a sedative along with the epidural, so they feel relaxed during surgery.

Incisions

Once the anaesthetic is working, the surgeon will sterilise the knee and make a small incision at the front of the knee. They will assess the bones in the knee and mark the area to be removed. This is then cut away, and the remaining parts are realigned and/or fitted together. The joint is secured with a metal plate that is screwed into place.

Closing the incisions

The incision at the front of the knee is then stitched closed with sutures or another method. The wound is then dressed, and the surgery is over.

Return to the ward

Patients will then be taken to the ward or recovery area and monitored as the anaesthetic wears off. Many patients will be able to go home on the same day, provided they have recovered from the anaesthetic and the surgeon believes it is safe, but sometimes an overnight stay is needed.

Follow-up appointments and physiotherapy.

The surgeon and physiotherapist will recommend a course of physiotherapy and any further treatments, if necessary, to aid healing. It is vital that patients follow their surgeon and medical team’s advice and recommendations throughout the osteotomy journey to get the best results possible.

Candidates for knee osteotomy surgery

Knee osteotomy can relieve symptoms of conditions such as osteoarthritis or alignment problems.

In osteoarthritis, it is important that patients only have symptoms on one side of the knee. Knee osteotomy is a great option for patients who have already tried medications (such as pain relief) and physiotherapy to improve symptoms but have not had good results.

The ideal candidate for knee osteotomy may also have the following characteristics:

• Be generally fit and well
• Have a BMI below 35
• Have symptoms that negatively affect everyday activities
• Be able to understand and follow recovery guidance, including physiotherapy
• Does not suffer from rheumatoid arthritis or another inflammatory condition
• Has an otherwise healthy knee with no ligament or kneecap problems

To get the most out of the knee osteotomy and sustain the knee’s long-term health, it is very important patients understand and are committed to the recovery process. This includes attending all follow-up appointments and adhering to physiotherapy guidance. These exercises help ensure timely healing and aim to get the best results possible. If this is in doubt, the surgery will not go ahead.

Knee osteotomy risks and complications

As with all surgical procedures, there are potential risks and complications that patients should be aware of before agreeing to have a knee osteotomy. The surgeon will be happy to discuss these in full ahead of the operation or at any step along the way.

The risks and complications related to knee osteotomy include:

General surgical risks

Every surgery comes with risks. These can range in severity and may include complications with anaesthetic, nausea, vomiting, post-operative pain, and blood clots.

Swelling and bruising

The knee is prone to bruising and swelling after arthroscopy. These tend to resolve after a few days. The doctor may prescribe pain medication to help to limit any discomfort felt because of bruising or swelling.

Infection

Infection is a risk of any surgery. This can be a serious complication and may require antibiotics and/or further surgery to treat.

Signs there may be an infection include:

• Feeling feverish with a temperature above 38° C
• Increasing redness or swelling around the wound site in the first two days after surgery
• Yellow pus or foul-smelling fluid coming from your incisions
• Pain that is not relieved by painkillers

If patients believe they have an infection, seek urgent medical advice and contact the surgeon.

Bleeding

Bleeding in the knee is a common complication after knee osteotomy. It may cause excessive pain and swelling after the procedure. If the bleeding is severe, it could require further treatment or revision surgery.

Damage to surrounding structures

The surgeon will always aim to avoid damaging any part of the body during surgery; however, damage may occasionally happen because of the way the leg and knee must be moved during surgery.

Damage to nerves, ligaments, or blood vessels near the knee may cause the following symptoms:

• Loss or change in sensation
• Mobility issues
• Pain
• Bleeding

While uncommon, these complications may result in the need for further or revision surgery.

Knee osteotomy preparation

Although some people return home the same day, patients may wish to do some preparation at home to help make their recovery as relaxing as possible. It is important to remember that it may take time to return to previous mobility, and patients may be in some discomfort. Furthermore, the surgeon may advise the patient to avoid certain activities altogether for a while. Some suggestions for preparation:

Smoking

Smoking and the use of nicotine products like e-cigarettes or nicotine gum interfere with wound healing and increase the likelihood of complications. This is because nicotine constricts blood flow and slows healing as a result. It is recommended patients stop smoking and using nicotine at least six weeks before and after the procedure.

Housework

Everyday chores may be very difficult or advised against for a few days after returning home after having a knee osteotomy. It is recommended to get as much done around the house before going to the hospital. It is also a good idea to stock the kitchen and prepare and freeze meals so patients can eat healthfully as they heal instead of worrying about cooking or relying on takeaway food that can be high in salt, which in turn increases swelling.

Child and pet care

Patients may find it helpful to arrange for extra support from friends, family, or a sitter to care for children and/or pets while they recover.

Transport home from the hospital

Patients will not be able to drive themselves home after the hospital on the day of the surgery because of the effect of anaesthesia on their judgement and coordination, so ensure there is transport arranged beforehand.

The surgeons will advise on when the patient can begin to drive again, which may be several weeks. Consider making alternative transport arrangements until driving is possible again.

Clothing

Wear loose trousers, shorts or a skirt on the day of the surgery and be prepared to wear these types of clothes as you heal. This ensures the clothing does not rub on the surgical wound on the knee as you heal. Choosing loose-fitting clothing can also make dressing and undressing much easier.

Knee osteotomy aftercare

After the knee osteotomy, patients will likely go home the same day as the surgery or the next day. The medical staff looking after the patient will encourage them to stand up and move on their own. When patients can do this, they will be able to go home, providing that everything else regarding the recovery is fine. Patients will need to use a mobility aid like a walker or crutches for between six to eight weeks and will be able to bear their full weight on the knee between two to three weeks after surgery.

Time away from work

The time patients need away from work is dependent on their health and the type of work they do. If patients have a low-impact job (for example, in an office setting), they will be able to return to work when they can safely and comfortably travel to and from work. Depending on how quickly patients heal, this could take up to six weeks.

If the patient's work is more labour-intensive, they may need to be away for up to three months. The surgeon and physiotherapist will be able to provide patients with a more precise estimate as to how much time they will need away from work to heal.

Driving

As with work and sports, patients may only return to driving after they have healed when they can safely control a vehicle. The range of movement and strength of the knee will be the deciding factors in this. It may take patients up to six weeks to comfortably and safely drive.

Dressing and stitches

The incision will be closed with sutures or staples after surgery, and a dressing will be applied to keep the wound protected as it heals. A dressing will need to remain on the incision until the sutures or staples are removed.

Patients should not submerge or wet the surgical wound before the sutures are taken out. The surgeon will tell the patient when it is safe to bathe or shower again fully.

Physiotherapy

Physiotherapy is a crucial component of healing from knee osteotomy. Patients will likely see your physiotherapist weekly. During these appointments, patients will learn exercises that help improve the strength and mobility of the knee as it heals. Attending these appointments and performing the exercises and stretches at the recommended intervals (once to three times a day) is vital to ensure patients heal well after knee osteotomy.

Patients may also need hydrotherapy during the healing process, meaning they will do exercises in a warm pool to reduce the stress on the knee as they exercise.

Final results

Every patient heals at a different rate, so it is difficult to estimate when patients will experience the final results of their knee osteotomy. A majority of patients find relief from knee pain soon after their osteotomy. Generally, many patients are able to resume their normal activities, sports, and hobbies after six months, though full recovery may take up to 12 months for some.

People vary greatly and it is, therefore, difficult to give a generalised answer to this type of question. If the aim of an osteotomy is to relieve pain, then you may see an improvement soon after the procedure. In general, most people do see improvements after knee osteotomy surgery. Your surgeon will discuss your goals and the post-op physiotherapy process to help you decide if it is a realistic way for you to achieve your goals.

In general, knee conditions can be treated in several ways:

• Conservatively - with rest, physiotherapy and rehabilitation.
• Medically - with anti-inflammatory or pain killer medications.
• Surgically - with a procedure such as an osteotomy.

If you have not tried all the non-surgical options, it may be advisable to discuss these with your doctor before considering surgery. here are risks associated with any surgery and these may outweigh the benefits of an operation if it is not necessary.

A surgical alternative to an osteotomy is partial or total knee replacement. Osteotomies can be a better option for younger people as knee replacements can wear out in time and may need replacement (revision) every 10 to 15 years, meaning the potential for multiple replacements in a lifetime. Further, revision surgery can be more challenging to perform, and results are not guaranteed.

Your surgeon will explain the alternative treatment options, answer any questions you have, and help you come to a decision that is right for you.

Recovery varies from patient to patient. This ultimately depends on the type of osteotomy, your general health, as well as your underlying knee problems. You will likely be given crutches to use for the first two to four weeks and may be able to gradually return to some physical activity after this.

You may be able to return to work if safe to do so when still using your crutches. This depends on your occupation, whether it is safe to do so and your surgeon's advice. It may take several months of physiotherapy and recovery before returning to higher-impact activities and sports. Your doctor and physiotherapist will give you a personalised timeline for what to expect.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/knee-replacement/ NHS
• Uptodate.com Up to Date