Double Osteotomy (DFO + HTO)

A double osteotomy combines the DFO and HTO procedures in order to realign the bones on either side of the knee joint. The surgery is performed when single osteotomy above or below the joint will not adequately address the deformity. Titanium plates securely hold the bone until healing occurs.

When is it Performed?

A double osteotomy combines an HTO and a DFO in one operation to realign the knee and reduce the pressure on the damaged joint. It is most commonly performed where there is a more severe deformity in the limb and where the deformity lies in both the femur and the tibia. If all of the correction in a severe deformity is performed in just one bone there is a risk of poor outcome because the joint line may not remain horizontal. The knee will need to be carefully assessed in order to determine whether double osteotomy is a suitable treatment. Mr Dawson has researched accuracy in this procedure and now regularly uses the NuVasive nail in double osteotomy. This allows post-operative correction to fine tune the accuracy achieved.

The Procedure

Osteotomy is a procedure that involves cutting bone and then fixing the pieces created into new positions. The commonest procedures are called opening or closing wedge osteotomies. In these operations the bone which is cut is left connected at a hinge about which the bone pieces are corrected by rotation of around 5-15 degrees. In opening wedge osteotomy a gap is created by separating the cut surfaces held at one side by a hinge. The gap created is often filled with bone graft. In a closing wedge osteotomy a small wedge of bone is removed and the gap created closed down so that the surfaces meet - the hinge remaining intact. The operation will be carefully planned so that the bone can be positioned correctly in order to redistribute the weight borne by the knee.

• You will usually spend one or two nights in hospital after a double osteotomy. You will need to use crutches for about six weeks after you go home. You will be allowed to touch toe weight bear for 2-4/52 and will not be allowed to fully weight-bear for 6 weeks. Physiotherapy will help you to recover your strength and mobility. You should be able to return to most everyday activities after about 8 weeks, but strenuous physical activity should be avoided for about 12 weeks.

Risks and Benefits

All surgical procedures carry a low risk of complications such as blood clots, infection and allergic reactions to the anaesthetic. The doctor will explain these in detail before the procedure.
The procedure can relieve symptoms such as pain and mobility problems. It can also prevent further damage to the knee joint, which could reduce the risk of more severe symptoms or requiring further treatment in the future.

If you would like to learn more about the double osteotomy procedure and find out if it is right for you, make an appointment to meet with an experienced specialist at the Cumbrian Knee Clinic.

Double Osteotomy (DFO + HTO) Physio Protocol

Download Double Osteotomy (DFO + HTO) Physio Protocol

Matt Dawson is a Specialist Knee Surgeon with over 16 years Consultant experience. Matt is internationally renowned as one of the leading authorities on knee realignment surgery