Osteotomia significa letteralmente “taglio dell’osso”.

In un’osteotomia di ginocchio, la tibia o il femore, vengono tagliati e riallineati per ridistribuire correttamente la pressione all’interno del ginocchio.

Si ricorre all’osteotomia come intervento di salvataggio in alternativa o in attesa di un intervento di protesi di ginocchio, in un quadro di artrosi di ginocchio con presenza di ginocchio “varo” o “valgo”.

Normalmente l’asse meccanico di carico dell’arto inferiore passa per il centro del ginocchio, le forze di carico sono quindi distribuite uniformemente su tutta l’articolazione.

 

Nel caso del ginocchio varo (gambe ad “O”) il comparto interno del ginocchio viene ad essere sovraccaricato, causandone la progressiva usura. Nel ginocchio valgo (gambe ad “X”) è il comparto esterno ad essere maggiormente sollecitato dalle forze di carico, e risulta danneggiato (Fig. 1).

Fig. 1 Load axis of the knee. The figure shows (in red) the load axis (force transmission axis) in the case of a normal knee, a varus knee ("O" legs) or a valgus knee ("X" legs) .

By realigning the knee and shifting the weight-bearing axis from the damaged to the healthy compartment, an osteotomy can significantly reduce pain and improve function. Furthermore, a major advantage of this type of surgery is that it does not involve any limitation of physical activity. One can therefore continue to participate in any sport, even high-energy sports (football, skiing, basketball). [1-3]

 

 

 

The purpose of knee osteotomy surgery is to re-establish the correct alignment of the lower limb and in this way redistribute the loads on the knee joint.

 

There are several reasons why the orthopaedic surgeon may recommend osteotomy surgery:

 

  • monocompartmental arthrosis in young, active patients (under 55-60 years of age): osteotomy surgery is recommended in cases where only one of the knee compartments is damaged by the arthrosis (most frequently, it is the medial compartment that is affected). The rationale is to shift the load forces from the diseased compartment to the healthy one. A young, active patient who plays sports and is able to convalesce quickly is certainly an ideal candidate for osteotomy surgery. Moreover, in these cases, osteotomy is preferable to prosthesis because it allows contact sports (running, football, skiing).
  • fracture outcomes: deviations of the knee axis can often be caused by previous fractures, which have been consolidated with angular deviations. in these cases an osteotomy can restore the correct alignment and prevent or delay the onset of arthrosis
  • prevention of arthrosis in young patients: osteotomy surgery is also used as a means of preventing arthrosis in a knee that does not yet have it, but has deformities at risk. Young patients with varus or valgus deformities (“O” or “X” legs) with recurrent pain symptoms are ideal candidates for this type of surgery.

The surgeon will choose the best surgery based on the individual case, assessing which bone segment is affected by the deformity and the degree of correction required. [4]

 

The most frequently used types of osteotomy are:

 

  • for valgus deformities: opening lateral femoral osteotomy (Fig 2)
  • for varus deformities: medial tibial osteotomy in opening (Fig 3)
Fig. 2 Radiographs of the lower limbs in a patient with varus knees, pre- and post-operative comparison in outcomes of varising femoral osteotomy
Fig. 3 Radiographs of the lower limbs in a patient with varus knees, pre- and post-operative comparison in outcomes of valgus tibial osteotomy

Osteotomy can be combined with other surgical treatments such as anterior cruciate ligament reconstruction or the treatment of meniscal injuries. [5]

In most cases, hospitalisation lasts 3-4 days.

Most patients start exercising their knee the day after surgery with the help of a physiotherapist. After 7-10 it will be possible to resume a sedentary work activity, after 2 months a heavy work activity. [6]

Curriculum of Prof. Marcheggiani Muccioli

Giulio Maria Marcheggiani Muccioli, MD, PhD has distinguished himself in the field of orthopedics, starting with a degree with honors in Medicine and Surgery, obtained from the University of Bologna in 2006, followed by a specialization with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute of Bologna and a PhD in Surgical Sciences.

His career includes the academic role of Associate Professor in Orthopedics at the Faculty of Medicine and Surgery of the University of Bologna, where he researches in the field of biomechanics and pathology of the lower and upper limbs.

He has expanded his skills through international fellowships, including experiences in the United Kingdom, Japan and USA, consolidating himself as an Orthopedic Surgeon with extensive practical experience (he performs over 250 operations per year).

Finally, he contributes significantly every year to the training of new generations of doctors through university teaching in multiple medical and surgical disciplines.

He is one of the 10 Italian surgeons who over the last 20 years have been selected by the American Knee Society to participate in the prestigious John Insall Fellowship on Prosthetic Knee Surgery.

His wrote over 250 scientific publications. He attended more than 100 international meetings. This demonstrates his commitment towards innovation in the treatment of knee and shoulder pathologies, and in the advancement of new surgical techniques.

Bibliography

1. High Tibial Osteotomy: The Italian Experience. Marcacci M, Zaffagnini S,…Marcheggiani Muccioli GM, Bruni D, and Halvadjian R. Oper Tech Orthop 2007;17:22-28.

2. Comparison between Closing-Wedge and Opening-Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis. Sun H, Zhou L, Li F, and Duan J. J Knee Surg 2016 May;30(2):158–165.

3. Osteotomy for treating knee osteoarthritis. Brouwer rw et al. Cochrane Database of Systematic Reviews, no. 12, 2014.

4.Understanding osteotomy: a narrative review. Alesi D, Rinaldi V, Meena A, Marcheggiani Muccioli GM, Zaffagnini S. J Clin Orthop 2020 Jan-June;5(1):16-21.

5. Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees. Zaffagnini S, Bonanzinga T, Grassi A, Marcheggiani Muccioli GM,…, Marcacci M. Knee Surg Sports Traumatol Arthrosc. 2013 Apr;21(4):934-41.

 

6. Rehabilitation Following High Tibial Osteotomy. Aalderink KJ, Shaffer M, and Amendola A. Clinics in Sports Medicine Apr 2010;29(2):291–301.

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