Is Total Knee Replacement the Only Option for Young Women with Arthritic Knees? By Dr. Kashyap Solanki – Orthopaedic & Joint Replacement Surgeon, Mumbai.

Understanding Knee Arthritis in Younger Women

Knee arthritis is increasingly being seen in younger women (below 50 years) — often due to a combination of factors like:

• Previous injury (post-traumatic arthritis)

• Obesity and sedentary lifestyle

• Malalignment (knock-knees or bow-legs)

• Early-onset osteoarthritis or autoimmune arthritis (rheumatoid, lupus)

Pain, stiffness, and difficulty in movement can disrupt daily life — but Total Knee Replacement (TKR) isn’t always the immediate answer.

Joint Preservation: The Modern Approach

In the early and middle stages of arthritis, orthopaedic surgeons now aim to preserve the natural joint for as long as possible. One of the most effective surgical strategies here is a realignment or osteotomy procedure.

Realignment Surgery (Osteotomy): A Bone-Preserving Alternative

What Is an Osteotomy?

An osteotomy is a bone realignment surgery that corrects the abnormal angle or weight-bearing pattern of the leg. In many younger patients, arthritis starts in only one compartment of the knee — usually the inner (medial) side. This happens when the leg is slightly bow-shaped (varus deformity), putting more pressure on the inner joint surface.

Osteotomy corrects this imbalance, shifting the load from the worn-out side to the healthier side — allowing the cartilage to recover and pain to reduce.

Types of Realignment Surgeries

There are two main types of osteotomy performed around the knee:

1. High Tibial Osteotomy (HTO)

• Performed on the upper part of the shin bone (tibia)

• Commonly used for varus deformity (bow-legged alignment)

• The bone is cut and carefully opened or closed to change the alignment

• Fixed with a plate and screws until it heals

Goal: Shift the body weight from the damaged inner side to the outer, healthier side.

2. Distal Femoral Osteotomy (DFO)

• Performed on the lower part of the thigh bone (femur)

• Used when there is a valgus deformity (knock-knee alignment)

• Redistributes pressure from the outer knee to the inner side

Ideal for: Young women with arthritis mainly affecting the outer compartment of the knee.

Who Can Benefit From Realignment Surgery?

Osteotomy is best suited for:

• Young, active women (<55 years) with early to moderate arthritis

• Arthritis confined to one side of the knee

• Good range of motion and intact ligaments

• Healthy bone quality

It’s not suitable for patients with severe, multi-compartmental arthritis or advanced deformity — in which case TKR becomes the better option.

Advantages of Osteotomy

✅ Preserves the natural knee joint

✅ Delays knee replacement by 8–10 years

✅ Allows return to sports and active lifestyle

✅ Can be converted to TKR later if needed

✅ Improved pain and function in properly selected patients

Recovery and Outcomes

• Hospital stay: 2–4 days

• Partial weight-bearing starts within 2–3 weeks

• Full recovery and bone healing: ~3–4 months

• Excellent long-term outcomes in active individuals

With modern locking plates, computer-assisted correction, and precise angle calculations, osteotomies today are highly accurate and durable.

How Osteotomy Fits Into the Bigger Picture

Think of osteotomy as a “joint preservation bridge” —It gives young patients the freedom to continue their active years naturally and still keeps the door open for a future TKR if needed.

When to Choose Total Knee Replacement

Despite all joint-preserving efforts, some young women eventually require TKR when:

• Arthritis affects all compartments

• Pain persists despite injections and realignment

• There’s major stiffness or deformity

• Daily activities like squatting, sitting cross-legged, or climbing stairs become impossible

Modern TKR implants now last 20–25 years or more, and newer options like robotic-assisted surgery and gender-specific prostheses make outcomes excellent even in younger patients.

Insight

“Realignment surgeries like HTO or DFO are excellent solutions for younger women with one-sided arthritis. They preserve natural movement, relieve pain, and postpone knee replacement for several years — often changing a patient’s outlook completely.”

Takeaway

No — Total Knee Replacement isn’t the only option for young women with arthritic knees. With options like osteotomy, partial knee replacement, and lifestyle optimisation, you can protect your natural joint and maintain an active, independent life.

If pain is limiting your daily routine, consult an orthopaedic specialist early — the right intervention at the right time can make all the difference.