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A novel Knee Joint Preservation surgical procedure-High Tibial Osteotomy

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Hyderabad: SISA (Sai Institute of Sports Injury & Arthroscopy), celebrating its Silver Jubilee, hosted a two-day Global Standard workshop on Knee Joint Preservation, Live Surgery Conference 2024, on April 13th and 14th at HICC, Hyderabad. This is the 14th such Conference hosted by SISA deliberating on advanced techniques in Knee Realignment Surgery and related aspects. The event was aimed at not only enabling the orthopaedic surgeons to know about the finer aspects and techniques in the field but also help share their experience with the fraternity.

Over 400 surgeons from different parts of the country participated in the conference. Experts, including Dr K Raghuveer Reddy, Managing Director, SISA & Organising Secretary, Live Surgery Conference 2024; Dr Adrian Wilson, UK and Dr Kristian Kley, Germany and 20 other prominent surgeons from India shared insights into achieving positive outcomes using these techniques.

In knee joint preservation, both nonsurgical and surgical treatments are done to preserve natural knee joint. In contrast, knee replacement involves removing damaged parts of the knee joint and replacing it with prosthetic parts. Knee joint replacement is the option for patients with advanced arthritis. However, younger patients, particularly those under 55 years, who lead active lifestyles, experience high wear and tear on knee prosthesis. To address this condition, emphasis must be placed on repairing the knee rather than replacing to prolong natural knee function. This can be achieved through advanced knee saving surgeries such as Realignment operations, Meniscus (joint sponge) repair, Ligament, and Cartilage surgery.

A novel surgical procedure, High Tibial Osteotomy (HTO), showcased at the Conference involved cutting the shin bone just below the knee joint aimed at straightening a bow leg there by transferring some body weight load from the worn-out part of the knee joint to good part of the knee joint. It reduces pain from the worn part of the knee joint. It helps through mechanical realignment, load distribution, and has cartilage protective biological effects. HTO prolongs the life of a partly damaged knee and delays or even prevents the need for total knee replacement. Sometimes the precise and controlled cut is made just above the knee joint on the thigh bone depending on the location of the problem to reposition and align the leg.

Dr K Raghuveer Reddy said, the focus of the Live Surgery Conference 2024, being hosted in the Silver Jubilee year of SISA is Knee Joint Preservation treatment. The emphasis at the Conference was laid on joint repair instead of knee joint replacement, especially among the younger and active patients or even among patients with partially injured joints. The advanced High Tibial Osteotomy helps to delay or avoid total joint replacement and this procedure was the primary focus at the Conference. With Osteotomy one can fully recover within 6 to 12 weeks and most can go back to their normal life in six months and participate in sports or intensive activities within 12 months’ time.

Dr Kristian Kley speaking on the occasion said, patients of arthritis are generally told there is no treatment or joint replacement as the option, but there is something called joint preservation. In Japan the novel procedure of Osteotomy became popular overnight and today it’s become very common treatment for the management of arthritis of the knee and many other countries have adopted this procedure, it’s become a routine procedure now. Knee replacement in active people will not lost for long, studies in UK indicate it will not last more than 5 years in such patients, but in a sedentary 65 year old the knee replacement will last forever. If you look at how much the patients are happy with Total Knee Replacement, 10% of patients are delighted with Total Knee Replacement, 70% of the patients feel its hasn’t provided complete relief but better than earlier and 20% to 30% is the failure rate of Total Knee Replacement, where the patients feel it’s worse than earlier, often there is no cure for this. Among all surgeries for the arthritis of the knee, Osteotomy gives the highest level of satisfaction. Among Indians, the proportion of people suitable for Osteotomy is much higher than it is among others.

Dr Adrian Wilson said, the patients in their 40s or 50s are treated with Osteotomy, the objective is to prolong the period where one need not undergo joint replacement. Osteotomy is the correction of the alignment of the knee, which allows to follow a normal lifestyle and permits you to go back to normal daily activities, it allows a higher quality of life.

This knee preservation surgery is commonly done in individuals with mild to moderate-stage arthritis where one side or one half of the knee joint is worn out particularly those under 55. Another group that may benefit from knee osteotomy includes younger patients, including athletes and active older patients. It may also be considered for patients with specific knee deformities (bowlegs or knock knees) and knee instability issues contributing to their symptoms.

The advantages of Osteotomy are

Reduced knee pain without the need to replace the damaged knee joint

Improved range of movement and function like before

Almost no restrictions on daily activities and squatting

Natural knee stability compared to artificial knee joint

Ability to return to normal activities, including competitive sports, which is not recommended after knee replacement due to potential artificial joint wear

Rehabilitation of such patients may take between 6 to 12 weeks. Unless one’s job is highly active or involves manual labour, returning to work is typically possible after six weeks. After a brief rehabilitation period, individuals can usually resume normal activities within six months and sports within twelve months.

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