Definition and Overview

Osteotomy is a surgical procedure that delays the progression of osteoarthritisand the need for a joint replacement surgery. It can be performed to shorten or lengthen a bone (usually on the hip and knee) to improve its alignment, treat a fracture, or relieve some pressure on the affected joint by shifting the body weight. The procedure is usually carried out on the tibia (shinbone), which is found below the knee, and the femur (thighbone), which is on the upper part of the knee.

Who Should Undergo and Expected Results

Osteotomy is recommended for people who have osteoarthritis, a degenerative and incurable condition of the bone and joints characterised by the wearing away of the cartilage. If the wear is uneven, the gap between the bones can become narrow, making movement difficult and painful.

Candidates for osteotomy are also chosen based on:

  • Joints affected – Osteoarthritis can occur in many joints in the body including the neck, spine, and even thumb. However, it is often done on the hips and knees. It is not meant for individuals diagnosed with rheumatoid arthritis, as well as those who have pain underneath the kneecap.
  • Number of joints – Osteotomy is allowed only in patients who don’t have two problematic joints in the same body part. For example, only one knee is affected by osteoarthritis instead of two.
  • Overall condition – Osteotomy is recommended for patients who have mild to moderate case of osteoarthritis. Those with a severe case of the condition would require a joint replacement surgery.
  • Age – Osteotomy is typically not recommended for patients who are 60 years old and above and those who have a sedimentary lifestyle.
    Osteotomy can help delay the progression of the disease for many years since it can shift the pressure away from the old and diseased joint to the one that was added. It can also prepare the patient for an impending joint replacement surgery. Also, an osteotomy can improve function and mobility of the joints. Patients can continue doing physical activities including exercise and sports even after surgery. It may also reduce the level of pain often brought by the disease’s flare-up.

How Does the Procedure Work?

Prior to the procedure, the patient goes through several tests to assess the overall condition of the joint, which can help the doctor determine the most ideal method to use, the patient’s eligibility, and the possible outcome of the surgery.

During the actual procedure, the patient is administered with general anaesthesia with his vital signs like blood pressure and heart rate monitored by an anaesthesiologist. The surgeon then makes an incision just below the kneecap to access the affected bone and introduces a wire that serves as his guide. Depending on the patient's condition, the affected bone may be removed or opened.

If a bone wedge is removed and a gap is created between two bones, they will be linked together using plates and screws. On the other hand, in an open osteotomy, a graft material is used to get rid of the gap.

The procedure takes around an hour to complete, but the patient may have to stay in the hospital for 2 to 3 days for close monitoring. He may also have to wear a knee brace for a couple of weeks and undergo physical therapy or rehabilitation for at least a couple of months.

Possible Risks and Complications

The risks and complications of the surgery are minor and include infection in the surgical site and joint stiffness. The patient may also suffer from damaged nerves and vessels. In certain instances, the surgical site does not heal and bleed continuously, making the condition worse.

Reference

  • Crenshaw AH. Soft tissue procedures and corrective osteotomies about the knee. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 9.
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