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Please read carefully the information provided below. It is essential that you are familiar with all the steps of your treatment. This will ensure the greatest satisfaction and best possible result of the proposed treatment. The information provided is specific to Mr Vioreanu's practice. All the aspects below will be discussed in depth during the consultation. 

Mr. Vioreanu performs the modern iBalance High Tibia Osteotomy. This procedure was first performed in Ireland by Mr. Vioreanu in December 2014. Please read here for more details. 

First Consultation
During first consultation you will meet Mr. Vioreanu to discuss your knee problem. Mr. Vioreanu will determine what, if any, surgery is required.

The consultation will last as long as necessary, depending on the complexity of your knee problem. Mr. Vioreanu will perform a physical examination and will review all your imaging studies.

There is a fee payable for the consultation. Remember to bring the referral letter from the GP or medical specialist.

Appointments are realistically scheduled for all patients, mindful and respectful of time. The nature of medicine and surgery is not always predictable and delays might happen. Your understanding is appreciated during such circumstances.

Appointments are confirmed with an SMS alert the day prior. A cancellation fee is not charged, however a return phone call of inability to attend is appreciated.
Do I Need Surgery?
High Tibial Osteotomy is an appropriate surgical option in selected cases of arthritis affecting one side of the knee only. Osteotomy is most commonly performed for patients where the weight bearing surfaces of the knee joint become worn away on one side. The affected side of the joint is no longer smooth and free running and this leads to stiffness and pain.

Conservative Treatment

Please see the 2013 American Academy of Orthopedic Surgeons Guidelines for conservative treatment of Osteoarthritis.

It is always worth to try with conservative treatment before deciding for surgery.


Surgical Treatment

It should be stressed that this surgery is designed to allow patients to walk without discomfort, not to return them to sporting activities. Mr. Vioreanu recommends HTO in a select group of patients (i.e. males in their fifties and early sixties, non-smokers, low BMI and with mild/moderate arthritic symptoms) that failed conservative treatment. In this group of patients HTO surgery is very successful with success rates at 10 years after surgery of 90%. If the patient is nearing the age of 70, it is worth considering continuing with conservative measures for as long as possible so that when complete deterioration of the joint has occurred, joint replacement may be performed.

Risks for Surgery
There are always risks when having surgery, and you need to be fully aware of those risks before making your decision to proceed with surgery. Do not hesitate to ask questions of your surgeon, anaesthetist or of other medical specialists who are managing your health in the lead up to your surgery.

The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. Below is a list that covers the major risks and complications with Arthroscopic surgery. Additionally, there may be other risks, particularly if you have a complex medical history or particular conditions that need to be managed by a medical specialist.

General Complications Related to Surgery.

  • Pneumonia: Patients with a viral respiratory tract infection (common cold or flu) should inform the Surgeon as soon as possible and will have their surgery postponed until their chest is clear. Patients with a history of asthma should bring their inhalers to hospital.
  • Deep vein thrombosis and pulmonary embolus: Although this complication is rare following arthroscopic surgery, a combination of knee injury, prolonged transport and immobilisation of the limb, smoking and the oral contraceptive pill or hormonal replacement therapy all multiply to increase the risk. Any past history of thrombosis should be brought to the attention of the Surgeon prior to your operation. The oral contraceptive pill, hormonal replacement therapy and smoking should cease one week prior to surgery to minimise the risks.
  • Excessive bleeding resulting in a haematoma is known to occur with patients taking Aspirin or Non-steroidal Anti-Inflammatory Drugs - such as Voltaren, Arcoxia, Mobic, Naprosyn or Indocid. They should be stopped at least one week prior to surgery.
  • Infection. Surgery is carried out under strict germ free condition. Antibiotics are administered intravenously at the time of your surgery. Any allergy to known antibiotics should be brought to our attention. With these measures there is a less than 2% chance of developing an infection within the joint.

Complications specifically related to HTO surgery.

  • Neuromuscular Injury: injury to the peroneal nerve can occur in patients following high tibial osteotomy. This may result in sensory loss or muscle impairment example: foot-drop. Most patients recover without any permanent functional disability.
  • Injury to the blood vessels around the knee during surgery is a very rare complication (less than 1%).
  • Delayed or non-union of the osteotomy site may occur in 2 to 4% of cases. In such cases, further surgery is then required to get the bone to heal.
  • Other potential problems include postoperative stiffness, pain and wound problems.
Before Surgery

Choosing a date for surgery

After the consultation in conjunction with Mr. Vioreanu's Personal Assistant, you should decide on the time frame and a date that is most suitable to you. You will walk with crutches for around 6 weeks after the surgery and may need to take as much time off work. This should be taken into account when planning for a suitable date for surgery

Forms to be completed and signed.

You will receive an information package containing your admission, consent and questionnaire forms, which you will need to complete and send back to us.

Mr. Vioreanu collects information about each surgery for the purposes of patient management, but also uses information for research. You will be given a consent form, which is to be completed and given back to Mr. Vioreanu’s office.

Let us know.

You should inform us of any medical conditions or previous medical treatment as this may affect your operation.
It is extremely important that there are no cuts, scratches, pimples or ulcers on your lower limb as this greatly increases the risk of infection. Your surgery will be postponed until the skin lesions have healed.
You should not to tape, shave or wax your legs for one week prior to surgery.
Please use HIBISCRUB solution (Chlorexidine 4%) to wash your knee ONCE daily for 5 days prior to surgery. Wash the skin gently and do no scrub the area. You can find HIBISCRUB solution at a retail Pharmacy. 


Pre-operative testing.

You will receive a list of all pre-operative tests required prior to surgery. These are standard tests for all patients.

Managing your Medications.

Prior to your surgery we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions.

Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery.
We will let you know if this is something you need to do.

The night before surgery.

Please do not eat and drink after mid-night and try to have a good nights sleep.
During Hospital Stay

Admission to SSC.

You will be admitted on the morning of the surgery. Mr. Vioreanu's Personal Assistant will inform you of the exact time and place to go for your admission.
Do not forget to bring all your relevant imaging studies (Xray’s , MRI’s etc.) and relevant medical letters and tests.

Immediately after surgery.

You will wake up in the recovery ward and will have a bandage and a brace on the operated knee. The brace will stay on for 4-6 weeks after surgery and you will be able to band your knee in the brace. You will be given regular pain relief by the nursing staff in the form of an injection or tablet as required.

Mr. Vioreanu will come and discuss the surgery performed. You will then be transferred to the ward. A physiotherapist will visit you in the afternoon of your surgery, or the following day. They will show you some exercises for your leg and will get you up for a walk. You will begin walking with crutches and will need to avoid putting full weight through your operated leg. Once you are able to safely mobilise and care for yourself you will be discharged from hospital, usually 3-4 days after your surgery.

SSC In-hospital Handbook SSC In-hospital Handbook (1451 KB)


After Surgery
You will receive instructions and a prescription for pain-killers from our nursing staff prior to being discharged from hospital.

The next few days.

If you have any concerns about your post-operative recovery please do not hesitate to contact our office. Mr. Vioreanu will call you back at a suitable time to discuss all your concerns.

Swelling.

The swelling in your operated leg may take up as much as 4-6 months to fully resolve. To facilitate this we strongly advise to place 2-3 pillows under your bed mattress to keep the leg elevated at night time.

Bruising.

Bruising of the lower leg, calf and sometimes the thigh is not uncommon after HTO surgery. It will take 1-2 weeks to resolve.

Crutches.

You will walk with crutches for 4-6 weeks after surgery. The first 4 weeks you will avoid bearing any weight through the operated leg. At 4 weeks after surgery you may begin to take partial weight through your operated leg as instructed by Mr. Vioreanu at the follow-up appointment.

Driving.

Driving an automatic car is possible as soon as you can walk comfortably after surgery. You will not be fit to drive a car for at least 6 weeks after surgery.

Return to work.

Sedentary and office workers may return to work approximately 4-6 weeks following surgery.
Follow-up Appointments
Mr. Vioreanu will see you 6-8 weeks after HTO surgery for a clinical check. The following appointments will be at 6 months and 9-12 months after surgery respectively. You do need to contact our office to make these appointments. You do not need a referral letter for these appointments.

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