Femoral osteotomy (knee realignment surgery)

A femoral osteotomy is a surgical procedure that corrects deformities in your femur. Your femur is the long bone in your upper leg and hip joint. The operation involves cutting the bone and using mental plates to make sure it's correctly realigned and prevents you from experiencing any further pain and/or reduced mobility. You might have a deformity (when the bone doesn't grow correctly) for congenital reasons (inherited at birth), or it may be due to a fracture and/or something you developed, such as fibrous dysplasia (a chronic disorder where scar-like tissue grows instead of normal bone).

A private femoral osteotomy is usually only suggested after non-surgical treatments have failed. If children have an abnormally positioned thigh bone (femoral anteversion), the problem can generally be resolved with physiotherapy exercises. In cases where you are above the age of eight, your deformity is severe, and physiotherapy treatments don't work, your consultant may recommend that you have a femoral osteotomy.

If you would like to know more about femoral osteotomy, or other treatments for thigh and hip issues, our experienced consultants are here to help you. Call or book online today and you could have your initial consultation within 48 hours.

This page provides all the information you need about what to expect from a femoral osteotomy, from the conditions that can lead to the need for this type of surgery, to the average recovery timeline if you do need an operation.

A femoral osteotomy may be required if you have a femoral anteversion - an inward twisting of the thigh bone, which occurs mainly in children and causes their knees and feet to turn inward and have a bow-legged appearance. Some symptoms of this condition include:

• One leg being longer than the other
• Limping
• One hip being more flexible than the other

This occurs in up to 10 percent of children, and in most cases resolves itself over time. If the problem remains severe after the age of eight, however, it may be that you need a femoral osteotomy.

You might also require a femoral osteotomy if you have hip dysplasia, which is when you have a hip socket that fails to fully cover the top part of your upper thighbone, meaning your joint becomes either partially or completely dislocated and your leg rotates internally, and can lead to a series of symptoms, such as:

• Osteoarthritis (when constant pressure due to malalignment wears down the protective tissue around your joint, causing pain, swelling, and stiffness)
• Hip labral tear (injury to the tissue that holds the ball and socket parts of your hip together, causing pain and reduced range of motion)

Other reasons why you may need a femoral osteotomy include:

• Cerebral palsy (can cause severe muscle spasms that lead to your hips to coming out of their sockets)
• A broken bone that didn't heal well

To determine whether you need a femoral osteotomy, your consultant will take a full medical history, asking about how long your deformity has been present for, any symptoms, and whether you have had any past treatment.

They will then check the extent of your problem through observing your hip and upper thigh to see if there is any visible deformity. A physical examination may also be needed, which would involve confirming if your toes and/or kneecaps bend can inwards, moving your legs into certain positions to check for reduced movement, as well as observing your gait (how you walk).

Some tests may be required to confirm the extent of your deformity and whether surgery could be required. Your consultant will probably do an X-ray and/or CT scan, which provides clear images of your bones and tells them whether they are properly aligned or not. An MRI scan may also be ordered to check for inflammation and tissue damage caused by your femoral shaft not being placed correctly in its socket.

Non-surgical treatment

If the initial consultation with your consultant is for your infant, and it has been confirmed that the position of their femoral head within the hip socket is positioned incorrectly, your consultant will not recommend surgery. To start with, your infant will need to wear a soft brace (known as a Pavlik harness), which will hold the ball portion of their joint firmly in its socket, helping the socket form to suit the shape of the top of their femur. If this doesn't work, a full body cast may be used instead.

If your deformity is severe, and your symptoms have not improved with age and/or conservative treatments, your consultant may recommend a femoral osteotomy. They will explain everything you need to know before the procedure.

Prepare your home

In the first few weeks after your femoral osteotomy, you won't be able to put any weight on your feet, so making quick trips to the shop won't be an option. Ahead of your surgery, then, be sure to stock up on all the supplies you might need for when you're recovering and have them within close reach.

You should also take care to set up your recovery space on the ground floor, as this means you'll be able to avoid difficult trips up the stairs while you're resting. Also, remove any potential tripping hazards (loose flooring, furniture, general mess, etc.) prior to coming to the hospital.

Plan for a short hospital stay

After your femoral osteotomy, you'll need to stay at hospital for one or two nights. This allows us to check how you've responded to surgery, provide pain relief, and do any additional scans on your hip and upper thigh bone, along with giving you support for using crutches for when you do leave hospital. So, before your surgery, bring along anything that might make your stay more comfortable, such as loose baggy clothing or a laptop to keep yourself entertained.

Discuss medications with your consultant

Medications like aspirin, warfarin, anti-inflammatories, or any other blood thinning medications can cause unwanted bleeding during and/or after your surgery. If you are taking any of these, your consultant may recommend that you stop taking them two weeks prior to your femoral osteotomy.

Stop smoking

If you are a smoker, you'll need more general anaesthetic, which can cause breathing problems. Smokers are also more at risk of having heart issues due to surgery as well, and your overall recovery may be affected if you keep smoking after your surgery. As a result, we always recommend that you stop smoking at least one week beforehand.

Food and drink

Take care to eat a balanced healthy diet before your surgery. Being in good physical shape is important for surgery, so you may be encouraged to lose weight if you're obese. And, as always before an operation involving general anaesthetic, don't eat or drink anything after midnight on the day of your procedure, and avoid alcohol for 48 hours prior to visiting hospital.

A femoral osteotomy is performed under general anaesthetic, which means you’ll be asleep for the full operation and won’t feel any pain. The procedure tends to take around two hours, and follows a series of steps:

• Your surgeon makes an incision along your upper thigh bone near the hip joint (femur)
• Using X-rays, your surgeon will then pinpoint where exactly they will need to remove a small part of your femur and measure out the part that requires removal
• Using a special surgical instrument, known as an osteoma, your surgeon will cut the deformed part of your femur
• After this part of your bone has been removed, your surgeon will then put your femur in the correct position, closing the space by bringing the cut ends of the bone together or placing a graft between them, to ensure the top part of your femur fits neatly into your hip socket
• Once the femur is in the right place, your surgeon will attach a plate with screws or pins to the top of your femur, which ensures the femur aligns with the hip socket and keeps the bone in the right place as it heals
• After your surgeon has fixed your femur in the right place, they will close the incision, and you’ll be transferred to post-operative care

Everyone recovers from a femoral osteotomy at a different rate. Generally, you will make a full recovery after around six months, but this could be more or less depending on a series of factors, such as:

• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age

Recovering in hospital

For the first couple of nights after your femoral osteotomy, our healthcare staff will monitor your progress and provide any pain relief that you might need. On day two, you'll be gently encouraged to stand with a walker and start touch-down weight-bearing for small amounts of time, along with being taught how to use crutches, which you'll need to use for around six to eight weeks.

Three days to one month after surgery

After around three weeks, you should be able to make a return to work, provided your job is sedentary (e.g., a desk job), but please speak to your consultant about this first. You can probably only safely return to manual labour work after around 12 weeks.

During this period, you should rest as much as possible and take pain relief medication whenever you feel like you need it. You will also be given a rehabilitation programme by your physiotherapist, who will provide exercises that encourage maintained flexibility around your knee and hip joint, as well as ensuring you protect yourself from any excessive movements that might cause further damage. You might be encouraged to do hydrotherapy (stretches in the pool) along with a series of passive and active movements, depending on how you're recovering.

One to three months after surgery

You should be able to put weight on your leg after four to six weeks, but you should continue to be careful about any strenuous movements or walking for a long time. Eventually, as your physiotherapy programme steps up, you'll be able to do range of movement exercises for your hip, knee, and ankle, along with a series of strengthening and weight bearing exercises once you're ready.

After about three months, you should be able to return to most of your normal everyday activities, including driving, but intensive physical exercise - football, athletics, etc. - may only be possible after six to nine months.

Like with any operation, some complications are possible, but these are incredibly rare. Your consultant will explain all the risks to you before booking you in for surgery, along with taking the time to answer any questions you might have.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of femoral osteotomy

• Nerve palsy (a nerve disorder that comes from nerve compression)
• Failure to heal and continued hip stiffness