Osteotomy is a surgical procedure that involves carefully cutting and reshaping bone to correct alignment problems, relieve pain, and improve joint function, commonly performed on the knee, hip, jaw, spine, and other joints throughout the body.
What is Osteotomy?
Osteotomy is a surgical procedure where a surgeon carefully cuts through bone to change its shape, position, or alignment. The word itself literally means “cutting of the bone.” During this operation, surgeons may remove a section of bone, add bone tissue, or reposition existing bone to correct problems affecting how your joints work.[1]
This type of surgery can be performed on many different parts of your body. Common sites include your jaw, elbow, spine, shoulder, hips, knees, legs, toes, and feet. The procedure targets problems at your joints, which are the places where two or more bones meet. By reshaping or realigning these bones, surgeons aim to restore more natural movement and reduce discomfort that may have been affecting your daily life.[1]
There are many different techniques and variations of osteotomy procedures. Some are named after the surgeon who first developed them, while others are named based on how the bone is cut or adjusted. For example, you might hear terms like “wedge osteotomy” based on the wedge-shaped piece of bone that is removed, or specific names like Salter or Chiari osteotomy when referring to hip procedures.[1][6]
Why is Osteotomy Performed?
Surgeons perform osteotomy for several important reasons, all aimed at improving how your bones and joints function. One primary goal is to correct problems with the angle, bowing, or rotation of bones that have developed over time or been present since birth. When bones don’t line up properly, they can cause pain and make movement difficult.[1]
Another key purpose is to shift your body weight from a damaged area of a joint to a healthier area where the cartilage (the smooth tissue that cushions your bones) is still in good condition. This is particularly important in conditions like osteoarthritis (a disease where the protective cartilage in joints wears down over time), especially affecting the knee and hip. By redistributing the pressure, the surgery can significantly reduce pain and improve how the joint functions.[1][3]
Osteotomy also serves to correct the alignment of deformed or improperly joined joints. Sometimes bones heal in the wrong position after a fracture, creating ongoing problems. The procedure can straighten these bones and restore proper alignment. Additionally, surgeons may use osteotomy to shorten or lengthen bones when there’s a discrepancy in limb length or other structural problems.[1][6]
For younger, active individuals, osteotomy offers a valuable advantage: it can delay the need for joint replacement surgery for many years. By preserving your own bone and joint structure, the procedure helps maintain more natural joint function while buying time before more extensive surgery becomes necessary. After an osteotomy has healed, there are typically no restrictions on physical activities, allowing patients to participate in their favorite activities, even high-impact exercise.[3]
Common Types of Osteotomy Procedures
Knee Osteotomy
Knee osteotomy is one of the most common types of this surgery. During the procedure, either the tibia (shinbone) or femur (thighbone) is cut and reshaped to relieve pressure on one part of the knee joint. This is particularly useful when osteoarthritis has damaged just one side of the knee joint, leaving the other side relatively healthy.[3]
The surgery works by shifting weight off the damaged side of the joint to the area where cartilage is still healthy. Osteoarthritis can develop when the bones of your knee and leg don’t line up properly, putting extra stress on either the inner or outer side of your knee. Over time, this extra pressure wears away the smooth cartilage that protects the bones, causing pain and stiffness. The most common type is high tibial osteotomy, which is performed on the upper part of the shinbone.[3][4]
During a knee osteotomy, surgeons may use one of two main techniques. In a closing wedge osteotomy, a wedge-shaped piece of bone is removed, and the remaining bone edges are brought together. In an opening wedge osteotomy, the surgeon cuts the bone and creates a gap that is filled with a bone graft. Both techniques aim to realign the leg and reduce stress on the damaged cartilage.[4]
Hip Osteotomy
Hip osteotomy involves adjustments to either the hip socket or the upper part of the thighbone. Two main types of hip osteotomies exist: innominate osteotomies (adjustments to the hip socket) and femoral osteotomies (adjustments to the thighbone). These procedures are commonly used to treat hip dysplasia (a condition where the hip socket doesn’t properly cover the ball portion of the upper thighbone) and hip impingement.[6][13]
A periacetabular osteotomy (PAO) is a specific type of hip osteotomy used to treat hip dysplasia. During this complex surgery, the surgeon makes cuts through three pelvic bones around the hip socket to free it from its original position. The socket is then repositioned to provide better coverage of the ball of the hip joint and fixed in place with screws. This realignment helps prevent abnormal wear on the joint and reduces pain while improving stability.[15][20]
A femoral derotation osteotomy can be performed to correct version abnormalities such as excessive forward or backward rotation of the hip joint. The surgeon makes adjustments to the femur head or the upper part of the femur to achieve better alignment. Metal hardware such as plates or rods are used to stabilize the bone while it heals.[6]
Jaw Osteotomy
Jaw osteotomy realigns the bones of your lower jaw (mandible) or upper jaw (maxilla) with the rest of your head and teeth. This procedure fixes problems such as open bite, trouble chewing or swallowing, excessive teeth wear, receding chin, overbite, or underbite. These conditions can significantly affect your ability to eat comfortably and may also impact your appearance.[1]
After jaw osteotomy, you may need to wear braces before or after surgery to realign your teeth with your jaw. Recovery typically requires following an all-liquid diet for up to six weeks while the bone heals. In some cases, your jaw may be wired shut during this initial healing period to ensure proper alignment is maintained.[5]
Spine Osteotomy
Spine osteotomy is performed to correct spinal deformities. During this surgery, a wedge-shaped piece of bone is removed from a section of your spine to correct lordosis (excessive inward curve, also called swayback) or reduce kyphosis (excessive outward curve, also called hunchback). This procedure can significantly improve posture and reduce back pain associated with these spinal misalignments.[5]
Foot and Toe Osteotomy
Osteotomy procedures on the foot are commonly performed to correct bunions (bony bumps that form on the inside of the foot at the big toe joint). A segment of bone is removed from the big toe to straighten it and prevent it from pushing into the other toes. Various osteotomy techniques exist for bunion correction, with some providing more stability and allowing for earlier return to normal activities.[5][13]
A calcaneal osteotomy involves the heel bone and is used to correct deformities of the foot and ankle. This procedure involves a controlled breaking of the heel bone to realign the foot and redirect the pull of the Achilles tendon. Multiple surgical options exist for this type of correction.[13]
The Osteotomy Procedure
Preparation Before Surgery
Before your osteotomy, your surgeon will order several routine tests to check your general health and ensure you’re ready for surgery. These may include blood tests to check how well your organs are functioning, urine tests to identify any issues that might interfere with bone healing such as infection or diabetes, and an electrocardiogram to check your heart’s electrical activity. A chest X-ray may also be done to make sure your lungs are functioning properly.[1]
Imaging tests such as X-rays or computed tomography (CT) scans (detailed imaging tests that use X-rays to create cross-sectional pictures of your body) are crucial for developing the surgical plan. Your surgeon needs to determine the exact size, dimension, and angle of the bone section to remove or adjust. Sometimes the surgical plan is created using a computer to construct a three-dimensional model, ensuring the most precise approach possible.[1][4]
During the Surgery
On the day of surgery, you’ll receive anesthesia to ensure you’re comfortable and pain-free during the operation. Your surgeon may choose to numb only the surgical area with regional anesthesia, numb your body from the waist down with spinal anesthesia, put you to sleep with general anesthesia, or use local anesthesia for minor procedures.[1][5]
Your surgical team will use an antibacterial solution to sterilize the area around the surgical site, and a surgical cloth will drape the site to maintain sterility. The surgeon then makes an incision through your skin to access the bone. Guide wires are used to outline the area of bone to remove, which is often wedge-shaped but depends on the specific procedure being performed.[1][4]
A special surgical saw removes the outlined section of bone. After removing the diseased or damaged bone, the gap in your bone may be closed by bringing the bone edges together, or in some cases, a bone graft is inserted into the space. A bone graft (a piece of bone taken from another part of your body or from a bone bank) helps fill the gap and promotes healing. Pins, screws, staples, plates, or rods hold the bone in place or realign it as it heals. This metal hardware may be temporary and removed later, or it may remain permanently in your body.[1][2]
Recovery and Healing After Osteotomy
Hospital Stay and Initial Recovery
After your osteotomy, you can typically expect to spend one to three days in the hospital, depending on the complexity of your surgery and which joint was operated on. During this time, medical staff will monitor your pain levels and help you begin the initial steps of recovery.[1][15]
Physical therapy usually begins within a day or two after surgery. In the hospital, therapists will work with you on gentle exercises and teach you how to sit, stand, and walk properly. If your surgery involved a lower limb, you’ll learn to use crutches and how to avoid putting full weight on the operated leg. You may only take a few steps around your room the first day, gradually increasing your activity as you feel able.[15]
Pain Management
The surgical site will be quite sore after your procedure. Your doctor will likely recommend over-the-counter pain relief medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to manage discomfort. In some cases, your doctor may prescribe stronger pain medications called opioids, but these should only be used as directed and stopped as soon as the pain is manageable to reduce the risk of addiction. Most patients find they only need prescription pain medication for about seven to 21 days after surgery.[15][16]
Timeline for Healing
The length of time it takes to heal after osteotomy depends on several factors, including which bone was operated on, what technique the surgeon used, and your overall health. Generally, the initial bone healing period takes approximately six to 12 weeks. During this time, the osteotomy site needs to heal properly, and putting too much weight on it too soon can interfere with this process.[3][16]
For knee or hip osteotomies, you typically won’t be able to walk without assistance for several weeks or even months. You’ll need to use crutches during this period to protect the healing bone. Most patients use crutches for about six weeks, then may transition to a single cane or crutch as instructed by their physician until about three months after surgery.[5][15]
After the initial healing period, it takes additional time to return to all regular activities. For a knee osteotomy, patients may need to wait three to six months before returning to their usual activities and favorite sports. Full recovery can take up to a year, though most improvements are seen within the first several months.[3][16]
Recovery after hip osteotomy, particularly periacetabular osteotomy, follows a similar but potentially longer timeline. The first few weeks focus on rest and pain management. Months one to three show gradual improvement as physical therapy progresses. By three to six months, most patients find activities become much easier and may return to normal activities. However, full recovery can take 9 to 12 months to feel completely healed.[15][20]
Physical Therapy and Rehabilitation
Physical therapy is a non-negotiable part of recovery after osteotomy. It plays a crucial role in restoring strength and flexibility to the affected joint so you can return to daily activities without complications. Your therapy program will be tailored to your specific needs and will progress through several phases as you heal.[2][20]
In the early stages, therapy focuses on gentle movements to maintain some mobility without stressing the healing bone. As healing progresses, more active exercises are introduced to strengthen the muscles around the joint. These might include exercises to strengthen the thigh muscles if you’ve had knee surgery, or gentle bending and straightening movements of the joint. Gradually, walking and cycling exercises are added to build endurance and function.[19]
Consistently engaging in your prescribed therapy exercises is crucial for a smooth recovery. Many patients continue some form of exercise program even after formal physical therapy ends to maintain the strength and alignment achieved through surgery.[2]
Activity Restrictions
After osteotomy, you’ll need to follow specific activity restrictions to protect the healing bone. If your surgery involved the knee, hip, or other lower limb joints, you won’t be able to put full weight on that leg for weeks or months. Your surgeon will provide specific weight-bearing instructions based on your procedure.[16]
For foot procedures such as bunion surgery, you may not be able to wear regular shoes or drive for at least two weeks and sometimes up to six weeks. Daily activities will need to be adjusted during this time, and you may need help with tasks like shopping, cooking, and household chores.[5]
Possible Risks and Complications
While osteotomy is generally considered safe, like any surgery, it carries some risks. The risk of complications is relatively low, but it’s important to be aware of what could potentially happen so you can watch for warning signs and seek help if needed.[3]
Infection is one possible complication that can affect the surgery site. Signs of infection include swelling, redness or flushing of the skin, increased pain, pus, the wound reopening, and the area feeling warm to the touch. If you notice any of these symptoms, contact your doctor immediately, as infections require prompt treatment.[16]
Blood clots are another potential risk, particularly with lower limb surgeries. To reduce this risk, doctors typically prescribe blood thinners for about six weeks after surgery and may recommend wearing compression stockings. Keeping your legs elevated when resting and moving as much as safely allowed also helps prevent clots.[4][15]
Nerve injury can occur during surgery, particularly in hip procedures. Some numbness in the area near the incision is fairly common and usually temporary. More significant nerve damage affecting movement or sensation is rare but possible. There is approximately a 50 percent chance of experiencing some numbness over the front of the thigh after hip osteotomy, though sensation usually returns over time.[4]
Delayed healing or nonunion (when the bone fails to heal properly) is an uncommon but serious complication. This is more likely in people who smoke, have diabetes, are significantly overweight, or have other health conditions that affect bone healing. If the bone doesn’t heal properly, the hardware (screws and plates) can break, and the bones can shift out of position. Additional surgery may be needed to encourage healing.[4][18]
The joint may also feel stiff after surgery, which is why physical therapy and prescribed exercises are so important. In some cases, having had an osteotomy can make a later joint replacement more challenging if that becomes necessary in the future.[3][16]
Factors Affecting Healing Success
Several factors influence how well and how quickly your bone heals after osteotomy. Some of these are related to the surgical technique, while others depend on your overall health and lifestyle choices.[18]
One of the most critical surgical factors is achieving a minimal gap between bone edges after the osteotomy is closed. Research has shown that a smaller reduction gap is strongly associated with faster and more complete healing. When bones are aligned as precisely as possible with minimal space between them, they heal more reliably and quickly.[18]
The type of hardware used can also affect healing. Dynamic compression plates, which apply gentle pressure to bring bone edges together, may help bones consolidate more completely over time. The careful planning and execution of parallel cuts during surgery also contributes to better bone alignment and healing outcomes.[18]
Patient-related factors play an equally important role. Age affects healing, with younger patients generally recovering faster. Bone health matters significantly, so conditions like low bone density, osteoporosis, or calcium deficiency can slow healing. Medical conditions such as diabetes and thyroid disease also impact how well bones heal.[18]
Lifestyle factors are crucial and within your control. Smoking is particularly harmful to bone healing and significantly increases the risk of complications. Some surgeons will not perform certain osteotomies, such as periacetabular osteotomy, if you currently use any tobacco or nicotine products including cigarettes, vaping, patches, or gum. Excessive alcohol consumption also interferes with healing. Maintaining a healthy weight helps reduce stress on healing joints and improves overall healing capacity.[18][21]
Optimizing your health before surgery can significantly improve your outcomes. Starting several weeks before your procedure, focus on eating a well-balanced diet high in protein and consider an anti-inflammatory diet. Taking supplements of calcium, vitamin D, and a good multivitamin with iron supports bone health. Getting seven to eight hours of sleep each night and maintaining regular, gentle exercise such as stationary biking or walking helps prepare your body for the stress of surgery and recovery.[21]
Advantages and Considerations of Osteotomy
Osteotomy offers several important advantages, particularly for younger, active individuals dealing with joint problems. One major benefit is that it preserves your own natural bone and joint anatomy. By maintaining your original joint structure rather than replacing it, a successful osteotomy can delay the need for joint replacement surgery for many years, sometimes decades.[3]
After full healing from osteotomy, there are typically no restrictions on physical activities. Patients can participate in their favorite activities, including high-impact sports and vigorous exercise. This contrasts with joint replacement, which often comes with permanent activity restrictions to protect the artificial joint.[3]
The procedure also aims to correct the underlying structural problem causing joint pain and dysfunction, rather than simply managing symptoms. By realigning bones and redistributing forces across the joint, osteotomy addresses the root cause of discomfort. This can lead to improved function, reduced pain, and protection of the joint over the long term.[8]
However, osteotomy also has some disadvantages to consider. Pain relief is not as predictable as with joint replacement procedures. While many patients experience significant improvement, the degree of relief can vary from person to person. The recovery period is typically longer and more difficult compared to some other treatments, requiring patience and commitment to rehabilitation.[3]
The procedure is most appropriate for certain patient populations. Ideal candidates are typically younger patients (often under 50 or 60 years old) who are active and have early-stage arthritis affecting only one part of a joint. People with more severe, widespread arthritis or certain conditions like rheumatoid arthritis may not be good candidates for osteotomy and might be better served by other treatments.[19]
Preparing Your Home for Recovery
Taking time before surgery to prepare your living space can make your recovery much more comfortable and safer. Since you’ll have limited mobility for weeks after surgery, arranging your home properly is important.[21]
Remove any tripping hazards such as rugs, electrical cords, or random furniture pieces from walkways. This is especially important since you’ll be using crutches or other walking aids and your balance may not be as steady as usual. Make sure pathways between rooms are clear and well-lit.[21]
Set up a comfortable recovery area on the main floor of your home if possible, to avoid stairs. Get firm pillows for your recliner, couch, or bed to help with positioning. Place frequently needed items like your phone, medications, water, and entertainment within easy reach so you don’t have to get up constantly.[21]
Stock up on groceries before surgery, focusing on easy-to-prepare meals, frozen foods, and healthy snacks. You won’t feel like doing much cooking in the first few weeks. If you have children or pets, arrange for someone to help care for them during your initial recovery period.[21]
Consider getting a shower chair, sock aid, or leg lifter if your surgery involves a lower limb. These assistive devices can make daily activities much easier when you can’t bend freely or put weight on your leg. A raised toilet seat might also be helpful, particularly after hip surgery.[21]
