What Is an Osteotomy?
Osteotomy is surgical cutting and reshaping of bone. Osteotomies are used to repair or relieve pressure on a damaged joint or to lengthen or shorten a deformed bone to restore proper joint alignment. There are different types of osteotomy procedures, though the most common is a knee osteotomy. Other osteotomy sites include the hip, spine and big toe.
Common Reasons for an Osteotomy
People of any age may need an osteotomy to fix problems in their bones and joints. An osteotomy is one form of treatment for osteoarthritis. Over time, osteoarthritis wears and damages the cartilage that covers the ends of bones, called articular cartilage. This articular cartilage allows the bones to move smoothly against each other in the joint. Osteoarthritis destroys articular cartilage, eventually resulting in painful bone-on-bone contact and formations on the bone called osteophytes or bone spurs.
Osteotomies can be particularly helpful in cases of knee osteoarthritis, especially as a way to delay the need for a knee replacement. Knee osteoarthritis may cause the cartilage to wear down unevenly, narrowing the space between the femur (thigh bone) and tibia (shin bone). The result is a bowing of the knee inward or outward, depending on the affected side.
Other indications for osteotomies include:
- Congenital deformities
- Abnormal bony growths
- Symptoms of meniscus loss
- Excessive angulation/bowing/rotation of long bones
- Malalignment of a joint
- Limb length discrepancy (one is longer than the other)
- Pain relief due to arthritis (most prevalent in the hip and knee)
Common Types of Osteotomy
- Knee osteotomy. This procedure is most common in active younger people. Tibial osteotomy is performed on the tibia (shin bone) below the knee cap. Femoral osteotomy is performed on the femur (thigh bone) above the knee cap. This type of procedure shifts the body’s weight to the undamaged part of the knee joint to prolong the life span of the knee joint. A knee replacement is typically needed later in life.
- Hip osteotomy. Hip dysplasia and hip impingement are the two main conditions requiring a hip osteotomy. A section of the femur or the pelvis (rarely both) is cut and properly realigned with the joint. There are two types of hip osteotomies: femoral and periacetabular osteotomy (PAO). A femoral osteotomy is performed to correct femoral and hip joint deformities, including hip impingement. A PAO is a treatment for hip dysplasia, which can be present from birth. This condition may not present until adolescence or adulthood, though hip dysplasia is often congenital and is corrected in childhood.
- Calcaneal osteotomy. The calcaneus is the heel bone. This procedure differs from other common osteotomies in that it is a controlled breaking of the heel bone in the foot used to correct deformities of the foot and ankle. There are multiple surgical options for this procedure. Calcaneal osteotomies realign the foot as well as redirect the pull of the Achilles tendon.
- Bunion surgery. A bunion (hallux valgus) is a bony bump that forms on the inside of the foot at the big toe joint. Bunions develop slowly and are usually, but not always, painful. Bunion surgery is used to correct the alignment of the bones making up the foot and toe. There are various osteotomies for this condition. A Scarf osteotomy tends to be the most stable and allows for earlier return to work for most people.
- Spine osteotomy. This surgery is used to correct lordosis (swayback) or reduce a kyphosis (hunchback).
- Knock knee surgery. Knock knees are a pediatric condition in which angular deformities at the knees are present – the knees point inward. If a child standing normally has knees that touch, but the ankles do not, then knock knees are present. This is a normal stage of growth and development and knee alignment eventually returns to normal. However, in some cases, normal alignment does not return and interventions are required, such as leg braces. Only the most severe cases require a knee osteotomy after growth of the child is complete. Knock knees are self-correcting in 99 percent of cases, making this surgery very rare.
- Proximal femoral osteotomy (PFO). This surgery restores normal anatomy and joint alignment in the hip to help prevent long-term deterioration of the hip. This surgery is used to treat various hip disorders in children. There are two types of PFO.
- Periacetabular osteotomy (PAO). See hip osteotomy above.
How the Procedure is Performed
X-rays will be taken first to determine how much correction is needed. Anesthesia is administered. The type of anesthesia will be determined by the surgical team, including spinal or epidural anesthesia or general anesthesia. The surgeon will then make an incision on the area where the osteotomy is being performed.
Using a knee osteotomy as an example, the surgeon may remove a wedge of the tibia from under the healthy side of the knee. This is a closing wedge osteotomy. In an open wedge osteotomy, a wedge is opened on the painful side of the knee. A bone graft may be required to fill in the wedge. Screws, staples or plates may also be required to correct the deformity, depending on the type of osteotomy. Most osteotomies will take one to two hours.
The complexity of the procedure will determine is the surgery will be an outpatient procedure or require an overnight stay in the hospital. For certain osteotomies, crutches may be required up to two months. This will allow the bone to heal properly. A brace is occasionally provided for a knee osteotomy to help support the bone while it heals.
Exercises and possibly physical therapy will be prescribed in order to strengthen the muscles, increase range of motion, and improve balance. Full recovery may take as long as six months. For knee osteotomy, arthritis pain is relieved and can postpone the need for a knee replacement by 10 to 15 years. Performing exercises and returning to normal activity are crucial to a full recovery.
If you have knee or hip pain that hasn’t responded to other treatment and think you may need an osteotomy, or your child’s hip dysplasia or knock knees are affecting his or her quality of life, follow the link below and answer a few short questions. Someone will get back to you as soon as possible. Thank you for choosing Summit Health.