In certain circumstances the lining of your patella may be removed and replaced with a plastic ‘button’. This is a very effective method of reducing pain from arthritic knees. The procedure will take several weeks to get over the acute surgery and you will ‘settle in’ to your new knee rapidly and continue to improve over the course of 18 months. Evidence would suggest that more than 80% of patients are happy with a knee replacement. My feeling is that in my practice and in discussion with knee colleagues that this figure is anecdotally higher.
Osteotomy is the process of cutting bone and realigning the knee by pivoting on this cut area. This may be performed typically for the younger, active patient with arthritis or someone with chronic ligament damage. Scans and X-rays of the whole of your leg need to be taken to work out the way your weight goes through your knee. Using computer software we can work out how much we need to alter the shape of your bone. It involves changing the way that your weight is transmitted through your knee – essentially off-loading the painful part of your knee. This involves a cut to your tibia and/ or femur (depending on your wear and tear pattern and severity) changing the shape of your bone and fixing it in a new place to heal with a plate and screws. A bone graft may need to be taken to fill in the gap left in the bone. The most common type of osteotomy is for people who have arthritis mainly affecting the medial part of the knee – people who notice they are becoming more ‘bow-legged’. There are strict criteria to follow to ensure a good outcome. Poor outcomes can be seen in the older, smoker with more advanced arthritis.