Cartilage Restoration

Re-Alignment Procedures

We don’t really know why arthritis causes knee pain. Some factors are inflammation due to wear and tear on knee cartilage, abnormal joint stress that puts pressure on the knee joint, ligaments and other soft tissue, and mechanical stress that causes bone pain. Reducing and repositioning the bone reduces stress, inflammation, and joint pain.

What is a joint realignment?

Joint realignment is the shortening or lengthening of a patient’s bone to improve knee alignment. The procedure is called a knee osteotomy. The goal of a knee osteotomy is to:

  • Transfer weight from the arthritic part of the knee to a healthy area of knee cartilage
  • Correct poor knee alignment, and
  • Prolong the life span of the knee joint.

Benefits of a knee osteotomy

An osteotomy preserves knee anatomy and can delay the need for a joint replacement. Another benefit is there are no activity restrictions so patients can participate in their favorite sports, and high impact exercise, unlike with a knee replacement.

Potential disadvantages

• Pain relief is not guaranteed whereas a partial or total knee replacement provides predictable pain relief.
• Recovery is challenging and longer than partial or total knee, and weight-bearing activity delayed.

Who would benefit from a knee osteotomy?

Knee osteotomy is beneficial for young and active patients who have early stage osteoarthritis (OA) that affects only one side of the knee. OA can develop from poor bone alignment, when the leg bones do not properly line up. This creates abnormal joint stress, puts extra pressure on the smooth articular cartilage that covers the ends of bones, and accelerates the development of OA.

If not for this procedure, these patients would face a total knee replacement which generally lasts about 20 years. This means a young patient could outlive the knee replacement and require another knee replacement later in life.

Because of the significant success of knee replacements, osteotomy is less common, but it is an option for certain patients.

Who is a good candidate?

Good candidates are people aged 40-60 with only mild to moderate arthritis on one side of the knee, have no pain under the knee cap, and experience knee pain with activity and standing for long periods. The candidate must desire to remain physically active, be able to fully straighten the knee and bend it at least 90 degrees, and have good knee mobility. Additionally, the patient must be willing to commit to a long post-surgery rehab.

The procedure

The osteotomy is an open surgical procedure that requires a 4-5” incision on the front of the knee where the surgeon removes a wedge of bone from the tibia, or shinbone, or the femur (thighbone). The gap is closed with surgical fixation.

Rehabilitation is lengthy, but this surgery can improve function, allow younger patients to lead a more active life, delay the need for joint replacement, and reduce the risk of chronic knee arthritis.

Dr. Stark has offices in North County San Diego, Carlsbad and Oceanside.


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