Post Operative Knee Osteotomy Surgery

Re-alignment Osteotomy Surgery   

This booklet is for patients who have had re-alignment osteotomy surgery at Gateshead Health NHS Foundation Trust.  

What is Re-alignment Osteotomy? 

The word osteotomy means to “cut a bone”. Your surgeon will x-ray the whole of your leg to assess the alignment and decide where needs adjustment. This operation corrects the alignment of the leg by changing the shape of the bone by cutting then holding it in place with plates and screws.  

The bone cut could be above your knee, known as a distal femoral osteotomy (DFO), below your knee, known as a high tibial osteotomy (HTO) or both which is called a double level -osteotomy (DLO). Your weight-bearing status following the operation may vary depending on the type of procedure you’ve had.

Typically, HTOs are partial weight bearing so you will initially be protected weight bearing with crutches. The femur is more fragile so DFOs and DLOs are normally non-weight bearing with crutches initially, however this will be dependent on your consultants advice.

Goals of re-alignment surgery:  

• Improve knee alignment  
• Reduce knee pain 
• Make daily activities less painful  
• Increase the longevity of your knee 
• Delay the need for further knee surgery  
• Improve your quality of life  

Recovery after surgery

Goals of initial rehabilitation phase:

• Restore knee range of movement, especially being able to straighten the knee.
• Regain thigh strength 
• Reduce swelling
• Adequate pain control
• Regain normal walking pattern.

Discomfort

Post-operative pain, swelling, and bruising are a normal part of the recovery process. The muscles and tissues surrounding your knee will take time to heal. It is likely you will require pain relief medication on a reducing basis over several weeks following the surgery. Crutch use, ice, activity pacing and rest may help.

Following your discharge from hospital; you need to apply the ice pack three to four times daily for 15-20 minutes. You will be able to reduce the frequency after this time, but will find that you will benefit from ice therapy for up to three months to help manage the pain.  

If you have any concerns regarding managing your pain, please discuss this with your GP.

Swelling

Swelling and inflammation is a normal part of the healing process. Dependant on your surgery this can last up to a few months. Swelling of the leg is different for everyone and may cause the leg to ache and feel very heavy.  

Elevating your leg on a stool or on the bed will also help manage the swelling. Do not rest a pillow underneath your knee in a semi bent position. Although this may feel comfortable, it may cause problems with your movement and walking pattern.  

Swelling, inflammation and sometimes blistering are normal changes after osteotomy surgery.  If you believe this is excessive then you can contact your GP or go to your nearest A&E department  

When should I seek help?  

You should see your doctor urgently if you: 

• Have a sudden increase in severe pain, swelling or tenderness in the calf which is getting worse and not just related to pain expected while performing the exercises. 
• Have concerning pain, swelling or tenderness in the joint which is getting worse.
• Develop a high temperature and feel unwell.
• See fluid, pus or blood coming from the wound. 
• Develop new numbness or tingling near to the joint. 

Mobility and Walking Aids  

After your operation, it may be necessary for you to use crutches to help you walk. Your physiotherapist will provide you with a pair of crutches and show you how to use them.   

Once you are no longer using your crutches; please return them to the hospital.  You will be provided with further guidance from the outpatient physiotherapy staff as to when it is appropriate to gradually stop using elbow crutches.  

Stairs / Steps

If you are non-weight bearing your physiotherapist will show you how to complete the stairs safely

Going up stairs with a rail

Keep your crutch(es) on the step you are standing on.  

Step up with your un-operated leg, then your operated leg and then bring your crutch(es) up onto the same step. 

Going down stairs with a rail

Put your crutch(es) down first into the middle of the step below Step down with your operated leg and then follow by your un-operated leg. 

Going up stairs without a rail

Keep your crutch(es) on the step you are standing on.  

Step up with your un-operated leg, then your operated leg and then bring your crutch(es) up onto the same step. 

Going down stairs without a rail

Put your crutch(es) down first into the middle of the step below Step down with your operated leg and then follow by your un-operated leg. 

Exercises  

It is important that you continue doing the exercises that have been given to you by the physiotherapist on the ward.  These exercises should be completed three to four times a day.   

It is normal to experience additional discomfort whilst doing these exercises and for up to an hour afterwards. Try taking your pain medication before exercising and using an ice pack afterwards.  

Ankle pumps

Move your ankles up and down.

Repeat 10-20 times, 3-4 times a day

Heel Slides

Slide the heel of the operated leg along the floor and bend towards your buttock, trying to bend at your knee.

The physiotherapist on the ward would have explained and written on your front sheet of this leaflet what knee range of movement restrictions you have, do not exceed this range during this exercise.

Repeat 10 times, 3-4 times a day 

Thigh muscle (quadriceps) strengthening

Pulling your foot towards you and push your knee downward against the bed.  

Hold for 5-10 seconds, Repeat 10 times, 3-4 times a day  

Straight leg raise

Straighten your operated leg, pull your toes towards you and lift your leg to about 2 inches above the bed.  

Hold for 5-10 seconds, Repeat 10 times, 3-4 times a day

Seated leg raise  

Sit in a chair, pull your toes up towards you and tighten your thigh muscles to straighten your knee slowly.  

Hold for 5-10 seconds, Repeat 10 times, 3-4 times a day  

Seated Knee bend   

Whilst sitting with your thigh supported, slowly bend your knee as far as you can. If this is too uncomfortable or to increase the stretch; you can control the bend with your other foot.  

Hold for 15-20 seconds, Repeat 5 times, 3-4 times a day  

Gravity assisted knee stretch

If you are struggling to get you knee fully straight, you will benefit from leaving your knee in passive extension. Whilst you are sitting, rest with your heel on a pillow or stool without the back of your knee supported for as long as tolerated.  

Outpatient Physiotherapy

Once you have left hospital, you will receive outpatient physiotherapy rehabilitation. You should receive your appointments to attend outpatient physiotherapy via post after you leave hospital. This will be approximately two weeks after discharge.  

If you are a registered patientof a Gateshead or Newcastle GP, the Tyneside Integrated Musculoskeletal Service (TIMS) will be your physiotherapy provider.

If you are a registered patient of a Durham GP, the county Durham integrated MSK service will be your physiotherapy provider.

If you are an out of area resident (Registered to a GP out of Newcastle/Gateshead/Durham) the Queen Elizabeth Hospital will arrange your physiotherapy.

It is important that you attend outpatient physiotherapy. 

At this appointment the physiotherapist will:  

• Assess the progress you have made since your discharge from the ward.  
• Progress and guide on exercises.  
• Assess your walking and progress to the most appropriate walking aid.  
• Answer any queries you may have.  

Follow up appointments can be arranged for physiotherapy at this appointment if the therapist feels it is necessary.  

Please note:  If you have not received notification of your follow up physiotherapy appointment/s within 2 weeks of leaving hospital, please ring 0191 445 2320  so we can check your referral.  

On attending outpatient physiotherapy please wear comfortable clothing/ footwear that is suitable for exercise. 

Transport  

If you require an ambulance for transport to the group; you will be provided with a telephone number to ring and arrange this. This will be sent out with your physiotherapy appointment letter.   

Community Rehabilitation  

Occasionally people are discharged home using a walking frame. If appropriate; the ward physiotherapist may need to make a referral to the community team to review and progress rehabilitation at home. You will be contacted by either telephone or letter to advise when a visit can be arranged.   

Please note:  If you have not received notification of your follow up physiotherapy appointment/s within 2 weeks of leaving hospital, please ring 0191 445 2320  so we can check your referral.  

Telephone Numbers

If you are at all worried by your knee please contact us: