Normally, on a standing full length X ray of your lower limb (What we call a scannogram), the Weight Bearing Axis- the line of transmission of force of your body weight, passes through the centre of the hip joint, centre of knee joint and centre of ankle joint; meaning these three joints are aligned in a straight line.
Due to various contributing factors, this is not the case.
Alignment abnormalities are commonly associated with onset of arthritis (OA) and related problems. Early intervention in the form of realignment osteotomy will significantly slow down the progression of arthrosis and allow one to become active again.
It’s essential to understand the correct location of deformity; plan the required correction and then perform the appropriate procedure to realign the lower limb.
In close to 90% of patients with knee OA, there is bowing of the legs, meaning that the distance between the knees is increased leading to a bow leg deformity. This is commonly associated with a typical waddling gait. In such a scenario, through the inside of the knee- medial aspect, significant amount of force is transmitted- leading to collapse and further knee bowing.
If left untreated this quickly leads to damage to the ligaments and other stabilisers in the knee further causing a rapidly progressive OA in knee; the treatment for which is a Total Knee Replacement. If the alignment is addressed early on, then cartilage damage can be prevented/ slowed down and a normal function can be achieved along with delaying of arthrosis. Once the location and nature of deformity is ascertained, then appropriate realignment osteotomy is performed.
Osteotomy Planning: I use the "Traumacad" software (Brainlab, USA) to assess the exact nature [Location, severity and associated factors included] of the limb deformity. This software is very sensitive and allows me to plan the necessary procedure in great details.
Surgery: The surgical procedure itself is fairly straight forward and involves performing and fixing the osteotomy with a metal/ PEEK (a kind of specialised hardened plastic) plate. Most patients can start walking in 2 days' time with a gradual increase in weight bearing. In about 6 weeks the osteotomy heals and most patients are back to normal activities soon after that.
Interesting Case of the week
Fracture fixed arthroscopically along with Fibretape internal bracing.
Every month I will try and explain about my philosophy of managing knee problems. This is my way of looking at solving my patients' knee problems
Dr Bhushan M Sabnis
MS-Orth, DNB-Orth, MRCS (Edinburgh)
FRCS (Tr&Orth)- Edinburgh, Dip CAOS-UK-Glasgow.
Recent Televised Interview on management of knee arthritis. (in Marathi)
Dr Bhushan M Sabnis www.Kneesolutions.co.in
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