Tibial osteotomy with closed wedge is a surgical procedure used in cases where osteoarthritis has affected only one side of the knee joint. During this surgical procedure, a wedge of bone is removed from the outside of the tibia, under the healthy side of the knee. Following surgical removal of the damaged bone, the tibia is realigned so that pressure is shifted from the damaged side of the knee joint to the healthier side. When the surgeon closes the wedge, it straightens the leg. This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the damaged, arthritic side. As a result, the knee can carry weight more evenly, easing pressure on the painful side.
Tibial osteotomy with closed wedge involves an incision at the front of the knee, starting below the kneecap to access the upper end of the tibia. Care is taken to protect the nerves and blood vessels that travel across the knee joint. Once the tibia bone is exposed, the orthopedic surgeon determines the correct size of the wedge using guide wires. With an oscillating saw, a cut will be made along the guide wires through the upper tibia in the shape of a wedge. The surgeon takes out the wedge, and the two sides of the tibia are brought closer together and held in position with a metal plate or pins. This changes the angle of the tibia and helps straighten the alignment of the knee. After fixing the two edges of bone with a plate or pins, the surgeon stitches the skin together, and the leg is placed in a padded splint to protect the knee joint until the osteotomy heals.
In general, after an osteotomy, most patients are required to stay in the hospital for two to four days and will be monitored with pain medication. Patients may require braces and a cast for knee protection during healing. In addition, use of crutches is recommended for several weeks. During rehabilitation, a physical therapist may prescribe certain exercises to help maintain the range of motion and restore strength. The total recovery time for tibial osteotomy with closed wedge before resuming full activities is three to six months.