Proximal Tibial Osteotomy Surgery
Osteoarthritis usually affects the inside half (medial compartment) of the knee more often than the outside (lateral compartment). This can lead to Bow legs, or in medical terms, a genu varum deformity. The result is that the weight bearing line of the lower extremity moves more medially (towards the medial compartment of the knee). (It’s really all in the physics/biomechanics of the situation.) The end result is that there is even more pressure on the medial joint surfaces, which leads to more pain and faster degeneration.

The procedure to realign the angles of the lower extremity is called a Proximal Tibial Osteotomy. In this procedure a wedge of bone is removed from the lateral (outer) side of the upper tibia. This converts the extremity from being bow–legged to knock–kneed. This procedure cannot be expected to be always successful, and generally will reduce your pain, but not eliminate it altogether. The advantage to this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions to activity level. It is thought that this operation buys some time before ultimately needing to perform a total knee replacement. The advantages of the operation generally lasts for 6–8 years.

Total Knee Replacement
The ultimate solution for osteoarthritis of the knee is to replace the joint surfaces with an artificial knee joint. It is usually considered in people around the age of 60, (although younger patients sometimes require the surgery simply because no other acceptable solution is available to treat their condition). The main reason that orthopedic surgeons are reluctant to perform the surgery on younger individuals, is that the younger the patient, the more likely the artificial joint will fail. Replacing the knee the second and third time is much harder and the relative advantages seem to get less with each surgery.

Artificial knee joints can last between 12 and 15 years in an elderly population. Younger patients are more active and place more stress on the artificial joint, that can lead to loosening and failure earlier.

In total knee arthroplasty. The end of the femur is shaped so that the artificial implant will fit snugly. The tibial surface is then cut flat to accept the bottom portion of the artificial joint. The patella is also cut flat to accept the artificial patellar surface. The femoral surface is placed on the end of the femur. The tibial artificial surface is placed on the top of the cut tibia. The patellar button is then placed on the cut surface of the patella. The end result is that all moving surfaces of the knee are metal against plastic.

What is the difference between a Sprain and Strain?

A strain is an injury to a muscle resulting in partial or total tearing of the muscle. There are three levels: mild or first degree, moderate or second degree, and severe or third degree. They are caused by sudden movement, overuse, forceful stretching, violent contraction or unaccustomed repeated minor trauma.

Sprains are an injury of the joint, in which the bones momentarily come out of alignment such that joint structures i.e. ligaments, joint capsules and possibly tendons, will be torn. There are also three degrees of sprains. Sprains can be caused by a violent, sudden bend or twist beyond the normal range of motion of the joint.

Does the treatment of a strain and a sprain differ?

Treatment for both strains and sprains is very similar. Ice for the first 24–48 hours to decrease inflammation, compression and elevating the area will also help. Massage therapy would help to decrease swelling through lymphatic drainage and other techniques. Ultrasound, [LINK TO ULTRASOUND IN PHYSIOTHERAPY] performed by a physiotherapist, helps to decrease swelling and promote healing. Massage therapy can benefit the unaffected areas and compensating structures to prevent hypertonicity and trigger points.

In the situation of a second or third degree sprain you should first consult with your physician, or physiotherapist prior to starting massage.

Before starting an activity, including a walk, start off slowly to warm up the muscles and other soft tissues, and then gently stretch all the muscles you will be exercising. Also strengthening the muscles surrounding a joint can help to protect it from spraining. Then at the end of your workout always Stretch and cool down. Massage therapy helps to even out muscle imbalances and can reduce increased muscle tension. Both massage and physiotherapists can give you a proper stretching program to help balance muscle.