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Knee Realignment Surgery (Osteotomy)

Find out about the process and expected recovery time

Knee osteotomy is an operation whereby a bone is cut to shorten, lengthen, or change its alignment. The procedure is commonly used to treat people who are bow-legged or knock kneed. Knee osteotomy can be performed instead of total knee replacement surgery to correct the weight-bearing forces in an unbalanced knee joint. The operation is done under a general anaesthetic.

The knee joint is a hinge joint divided in to two parts. The inside of the knee joint (medial compartment) and the outside of the knee joint (lateral compartment). 

Realigning the knee helps prevent pain: and later down the line prevent the onset of early degenerative changes to either the medial or lateral compartment of the knee. A structurally normal knee joint has a good balance and alignment between these two compartments when standing. 

In some cases the knee may lean towards the outside or inside too excessively, which can cause abnormal and excessive loads on the medial (if the knee leans outwards) or lateral (if the knee leans inwards). In some cases this may need to be surgically corrected with knee realignment surgery. 

When you meet with your consultant surgeon they will ensure that you have the opportunity to ask any questions you may have about your osteotomy. They will discuss with you what will happen before, during and after the procedure and any pain you might have. Take this time with your consultant surgeon to ensure your mind is put at rest.

Genu valgum (knock kneed)

Genu valgum is commonly referred to as ‘knock kneed’, a condition where the knees angle in and touch when the legs are straightened. People with severe valgus deformities are typically unable to touch their feet together while simultaneously straightening the legs.

Mild genu valgum is relatively common in children up to two years of age, and is often corrected naturally as they grow and develop. However, the condition may continue or worsen with age, particularly when it is the result of a disease, such as rickets or obesity. Idiopathic is the term used to describe genu valgum that is congenital or has no known cause.

Genu valrum

Genu valrum or genu varus (Blount's Disease), commonly referred to as ‘bow-leggedness’, is a deformity marked by medial angulation of the leg in relation to the thigh, an outward bowing of the legs, giving the appearance of a bow. It is also known as bandy-leg, bowleg, bow-leg, and tibia vara. Usually there is an outward curvature of both femur and tibia, with at times an interior bend of the latter bone.

The cost of the surgery varies between locations. The cost includes all your hospital visits, such as initial consultation, the surgery and recovery afterwards when you are an inpatient. We provide high-quality care throughout your stay and we reflect that within our costs.

Knee realignment surgery involves several stages and takes place under a general anaesthetic. Using x-rays taken before the operation, the surgeon will assess the degree of realignment that needs to be undertaken. Once measured for the realignment, the surgeon uses special cutting instruments on the side of the knee and makes an opening wedge cut near to the top of the lower leg bone (tibia).

The surgeon is then able to realign the knee angulation by levering the ends of the tibia together at the wedge of bone. The fractured ends are secured with a strong plate and screws, and if necessary the surgeon will add bone graft to secure the fractured tibia further. The most common form of knee realignment surgery described here is termed a high tibial osteotomy.

Different techniques are used to realign a knee depending on the correction required. An opening wedge osteotomy is where the bone is cut with a saw and then opened up with chisels to create a wedge-shaped opening. A closing wedge osteotomy is where the bone is cut twice and the wedge removed.

Due to the serious nature of osteotomy surgery, recovery times may be extensive. Careful consultation with your consultant is important in order to ensure proper planning during a recovery phase. Tools exist to assist recovering patients who may have non-weight-bearing requirements and include bedpans, dressing sticks, long-handled shoe-horns, grabbers/reachers and specialised walkers and wheelchairs. 

To allow the fractured tibia bone to heal safely in the new alignment following surgery and avoid knee osteotomy problems, it is normal for osteotomy patients who have undergone knee realignment surgery to be non-weight bearing for six weeks. 

The specialist team will take further x-rays after this six-week period and check that the fractured ends have healed sufficiently to start weight bearing through the operated leg. 

After this initial period, physiotherapists: always supervise our patients and guide them through a comprehensive rehabilitation package until they are able to walk normally and are back to full activities of living and high-impact sports (if applicable). 

Initially, rehabilitation after knee realignment surgery will often comprise of simple range of motion and flexibility exercises to ensure full mobility to the knee is restored. Non-weight bearing strengthening exercises will also be advised to prepare the knee for more aggressive exercises later down the line. 

Higher level rehabilitation will involve weight-bearing exercises to restore optimum function and fitness to the operated leg. These types of exercises may include: 

· Wall squats 

· Lunges 

· Step ups 

· Leg press machine 

If successful, a knee osteotomy can stop hips from becoming arthritic and then needing a hip replacement or resurfacing at a later stage in life. 

These procedures are suitable for patients less than 40 years old. Older patients have poorer bone healing and will often progress to arthritis despite osteotomy. 

Specialists Offering Knee realignment surgery osteotomy

Mr Derek Bickerstaff

Consultant Orthopaedic Surgeon


BMI Thornbury Hospital

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Mr Nitin Modi

Consultant Orthopaedic Surgeon

MBBS, MS Orthopaedics FRCS (T&O), MS Orthopaedics, MRCS, FCPS Orthopaedics, Diploma Orthopaedics

BMI St Edmunds Hospital

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Mr Bhupinder Singh Mann

Consultant Orthopaedic Surgeon

BSc, MBBS, MRCS, FRCS, (Tr. & Orth.)

BMI The Chiltern Hospital 1 more BMI The Shelburne Hospital

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Mr Harold Nwaboku

Consultant Orthopaedic & Trauma Surgeon

MBBS (Lond), FRCS(ed), FRCS (eng), FRCS (Tr&Orth)

BMI The Cavell Hospital 1 more BMI The Kings Oak Hospital

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Mr Sanjiv Manjure

Consultant Orthopaedic Surgeon


BMI The Manor Hospital

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Mr Neil Hunt

Consultant Specialist Knee Surgeon


BMI The Huddersfield Hospital

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