Offered an osteotomy at 51 instead of a new knee. Has anyone here actually had one, and did it buy you the years they promise?

Consultation this morning and I did not get the conversation I was expecting.

Background: 51, cycling is most of my life, inner side of the left knee is worn and the outer side is apparently fine. I've been bow legged since school, family trait, my mother has the same legs and the same knees. I went in half expecting to be told I was too young for a replacement and to come back in ten years.

Instead he talked about cutting the shin bone and putting a wedge in to straighten the leg so the weight goes through the good side. Plate and screws. Crutches for weeks. Six months before I'm properly back to things. Then said, quite cheerfully, that I'd probably still need a replacement eventually anyway.

So my honest reaction sitting in the car afterwards was: why would I go through a big operation that doesn't cure it and doesn't rule out the other operation later? He clearly thought he was offering me something good and I nodded along, but I came away confused rather than convinced. Has anyone actually had one of these?

Never been offered one, and at my age and with wear on both sides of both knees I never will be. But my reading of it is that you've been offered something quite rare and you're annoyed about it, which is a first for this forum.

A bloke in my old golf club had it done, tibial one, about eight years ago and he was maybe mid forties at the time. He was on crutches for a good while and complained bitterly about the first three months. He was still playing eighteen holes last summer, which he absolutely was not doing before.

He did have a second operation to take the metalwork out later on, which he said was minor compared to the first. Worth asking whether that's part of the plan for you.

cyclelou said:

why would I go through a big operation that doesn't cure it and doesn't rule out the other operation later?

Because at 51 the thing you are buying is time in your own knee, and that is worth far more to you than it would be to most of us here.

I asked about this myself years ago and was turned down, so I'll say plainly what I was told and why it applies to you and not to me. An osteotomy is aimed at a narrow group: broadly thin, active people under 60, with pain on one side of the knee only, no pain under the kneecap, an alignment that can actually be corrected, and a knee that already straightens fully and bends past a right angle. Mine was worn in more than one compartment and I was the wrong side of sixty, so it was never on the table. You have just described yourself as the textbook candidate, right down to the bow legs, which is why he looked pleased with himself.

The trade-offs are real and he was honest about them rather than selling you something. Pain relief afterwards is less predictable than it is after a replacement, and the recovery is longer and harder, because the bone itself has to knit and that takes around six weeks before full weight goes through it. What you get in return is your own joint surfaces and your own ligaments, and once it has healed there are no restrictions on what you do with it, high impact included. Nobody says that to you after a knee replacement. Ask any of us with metal in the knee what we were told about the future of our running and cycling.

The "you'll probably still need a replacement eventually" line is not the admission of failure it sounded like in the car park. It is the whole point. The plan is to move that operation from your fifties into your sixties or later, and one thing worth asking him directly is whether having had the osteotomy makes that later replacement more technically awkward, because in some cases it does. The site's guide to the bone-realigning operation and who it suits lays out the criteria and the recovery in full, and the questions to ask your knee surgeon will get you a better second appointment than the first one.

What I would not do is turn it down because it isn't a cure. Nothing on the menu is a cure.

The only thing I'd add from the other end of the process. I was 68 when mine was done and the thing I mind most is not the operation, it's the twelve years before it when I was gradually giving things up and calling it getting older. If somebody had offered me a way to keep the cycling at 51 I'd have taken their hand off.

Update because a few people have asked.

Went back with a list. Answers: yes I'm a good candidate on alignment and yes it's medial only, plate stays in unless it bothers me, and he thinks a later replacement in my case would be manageable but not identical to a straightforward one. He also told me to stop smoking properly, not mostly, because of bone healing, which I had not expected and did not enjoy.

Booked for November. Genuinely torn even now. The six weeks of not weight bearing frightens me more than the surgery does, and I have no idea what I'll be like without the bike for that long. But the alternative is another decade of doing less and less, and Maureen's post is the one that keeps coming back to me.