Osteotomy

Osteotomy is a surgical procedure that cuts and reshapes bones to correct alignment problems, relieve pain, and restore movement to damaged joints throughout the body.

Table of contents

• What is an Osteotomy?
• Why is an Osteotomy Performed?
• Common Body Areas for Osteotomy
• How the Procedure is Performed
• Preparing for an Osteotomy
• Recovery and Healing Time
• Rehabilitation and Physical Therapy
• Possible Risks and Complications

What is an Osteotomy?

An osteotomy is a surgical procedure that involves cutting bone and sometimes adding bone tissue to reshape or realign your bones^[1]. The word osteotomy literally means “cutting of the bone”^[3]. This procedure can help fix alignment issues, relieve discomfort, and improve movement^[14].

Your surgeon can perform osteotomies on bones all over your body, including your jaw, elbow, spine, shoulder, hips, knees, legs, toes, and feet^[1]. The surgery is a treatment for problems at your joints — the area where two or more bones meet^[1].

There are many types of osteotomy methods and variations of these methods. They are often named after the surgeon who created the method or by how the bone is cut and reshaped or adjusted^[1].

Why is an Osteotomy Performed?

Your surgeon performs an osteotomy for several important reasons^[1]:

• To correct the angle, bowing, or rotation of your bones
• To correct the alignment of a deformed or misaligned joint
• To shorten or lengthen bones
• To repair a damaged joint
• To shift your weight from a damaged area of a joint to an area where there is more normal or healthy cartilage — the smooth tissue that covers the ends of bones and allows them to move smoothly against each other
• To relieve pain from osteoarthritis — a condition where cartilage wears away over time, especially in the knee and hip
• To delay the need for joint replacement surgery in younger, active people

An osteotomy is one method to relieve pain from arthritis, especially of the hip and knee^[6]. People of any age may need an osteotomy to fix problems in their bones and joints^[13].

The procedure is particularly helpful when osteoarthritis has damaged just one side of the knee joint. By shifting weight off the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in an arthritic knee^[3].

Common Body Areas for Osteotomy

An osteotomy can address many different types of bone and joint problems throughout the body. The most common areas include^[1][2]:

Knee

A knee osteotomy involves cutting either the tibia (shinbone) or femur (thighbone) and then reshaping it to relieve pressure on one part of the knee joint^[3]. This procedure is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint^[3]. By preserving your own knee anatomy, a successful osteotomy may delay the need for a joint replacement for several years^[3].

Hip

Hip osteotomy surgery involves cutting parts of the hip bone to improve alignment and reduce pain^[6]. A periacetabular osteotomy repositions the hip socket to provide better coverage of the ball at the top of the thighbone^[15]. This is often done to treat hip dysplasia — a condition where the hip socket does not fully cover the ball portion of the upper thighbone^[20].

Jaw

A jaw osteotomy realigns the bones of your lower jaw (mandible) or upper jaw (maxilla) with the rest of your head or teeth^[1]. This procedure fixes problems such as open bite, trouble chewing or swallowing, excessive teeth wear, receding chin, overbite, or underbite^[1].

Spine

A spine osteotomy can remove a wedge-shaped piece of bone from a section of your spine to correct a swayback or reduce a hunchback^[5].

Foot and Toes

Osteotomies are commonly performed to treat bunions on the foot^[2]. A segment of bone can be removed from your big toe to straighten it and stop it from jamming into your other toes^[5].

How the Procedure is Performed

The osteotomy procedure follows a careful, step-by-step process^[1]:

First, you will receive anesthesia — medication to prevent pain during surgery. Your surgeon may choose to numb only the surgical area, numb your body from the waist down, put you to sleep, or numb just the surgical site^[1]. For minor procedures such as on your toe, you may get local anesthesia that only numbs the site of the surgery^[5].

Next, your surgical team uses an antibacterial solution to clean the area around the surgical site. A surgical cloth covers the site^[1].

Your surgeon makes a cut through your skin. They use guide wires to outline the area of bone to remove, which is often wedge-shaped but depends on the procedure^[1]. A special surgical saw removes the outlined area of bone^[1].

After your surgeon removes the section of diseased or damaged bone, the gap in your bone is closed by bringing the bone edges together^[1]. Depending on your specific procedure, sometimes a bone graft — a wedge of bone taken from your pelvis or from a bone bank — is inserted into the space where the bone was removed^[5].

Pins, screws, staples, plates, or rods hold the bone in place or realign the bone as it heals^[1]. This metal may be temporary or may be permanently placed^[1]. Once the bones of the joint are repositioned, your surgeon will likely use a combination of pins and screws to stabilize the area^[2].

Preparing for an Osteotomy

Your surgeon may order some routine tests to check your general health before the procedure. These may include^[1]:

• Blood tests to check certain blood components levels and how well your organs are functioning
• Urine tests to check your general health and to identify issues that interfere with bone healing, such as infection or diabetes
• Electrocardiogram to check your heart’s electrical activity
• Chest X-ray to make sure your lungs are properly functioning before surgery
• X-rays or computed tomography (CT) scans to see your bones and joints to develop the surgical plan

Your surgeon needs to determine the exact size, dimension, and angle of the bone section to remove. Sometimes the surgical plan is made using a computer to construct a 3D model^[1].

It is important to prepare your body before surgery. Maintaining a healthy lifestyle can help decrease risks of complications both during and after surgery^[21]. You should stop all nicotine products, as smokers have more difficulty with anesthesia and higher risk of delayed bone healing and infections^[21]. Eating a well-balanced diet high in protein and taking daily supplements of calcium and vitamin D can also help^[21].

Recovery and Healing Time

The time it takes to heal after an osteotomy depends on the bone that the surgeon is reshaping and the technique they use^[16]. Healing from an osteotomy takes time. The site of the surgery will be very sore^[5].

According to medical experts, the initial healing period for a knee osteotomy will be around 6 weeks^[16]. People can usually leave the hospital 1 or 2 days after the surgery but may need to use crutches for a few weeks^[16]. After the initial healing period, it can take longer for people to return to their usual activities. In the case of a knee osteotomy, people may need to wait 3 to 6 months after surgery before returning to all their regular activities^[16].

Hip osteotomies can take 6 to 12 weeks to heal^[16]. You will be walking within a couple of days of surgery, but on one to two crutches for three months, and it usually takes 9 to 12 months to feel fully recovered^[15]. The hospital stay for an osteotomy is usually two to three days after surgery^[15].

A jaw osteotomy can take several weeks for all post-surgery discomfort to disappear^[16]. After a jaw osteotomy, you may need to be on an all-liquid diet for 6 weeks, and in some cases, your jaw may be wired shut during this time^[5].

During recovery, you need to allow your bone to heal and should not put pressure on it right away^[5]. For instance, if you have a knee or hip osteotomy, you will not be able to walk for several months and will need to use crutches^[5].

If you are overweight and have a high body mass index, it might take longer for you to heal. Smoking can also slow healing^[5].

Rehabilitation and Physical Therapy

Your doctor will want you to have physical therapy that can help you strengthen your muscles and regain your balance^[5]. A physical therapist may recommend rehabilitation exercises to help the affected area rebuild its strength and remain mobile^[16].

Physical therapy is a necessary part of your recovery after an osteotomy. It helps restore strength and flexibility to your joint so you can get back to daily activities without complications^[20].

Starting the day after surgery, you will have physical therapy that includes gentle exercises and learning to sit, stand, and walk with partial weight-bearing and crutches^[15]. Programs include strength preservation, restoration of joint range of motion, and balance and coordination work^[4]. Increased muscle strength and joint stability improve performance and reduce injury risk^[23].

Healing from this procedure takes time and will involve physical therapy and many weeks followed by months of recovery as your bones begin to heal themselves^[2].

Possible Risks and Complications

Medical experts suggest the risk of complications after an osteotomy is low. However, they are still possible^[16].

The major risks include^[4][16]:

• Blood clot — Risk is reduced by using blood thinners, compression stockings, and compression boots on your feet to increase circulation
• Infection — Signs include swelling, flushing of the skin, pain, pus, wound reopening, and the area feeling warm to the touch. You are given antibiotics before surgery, which continues for 24 hours after, and doctors keep a close watch of the area for redness or drainage
• Nerve injury — There is a chance you will have some numbness, and over time sensation usually returns. Bigger nerves can get stretched with a large correction, but this is very rare (less than one percent)
• Failure to heal — This is uncommon but always a concern, especially if you smoke. If the bone does not heal, additional surgery to increase bone healing could be needed
• Joint stiffness — The joint may feel stiff after an osteotomy

Pain relief is not as predictable after osteotomy compared with a partial or total knee replacement^[3]. Recovery from osteotomy is typically longer and more difficult than joint replacement because you may not be able to bear weight on your operated joint right away^[3]. In some cases, having had an osteotomy can make later total knee replacement surgery more challenging^[3].

It is important to attend any follow-ups or post-surgery appointments so the doctor can ensure your recovery is going as it should^[16].