Osteoarthritis is a common condition that afflicts millions of people around the world. It develops when the bones in the knee do not align properly. This puts extra pressure on the knee and can lead to wear and tear of the protective knee cartilage, causing arthritic knees with pain and stiffness. Orthopaedic surgeons can perform a type of knee surgery called osteotomy to relieve pain and delay the progression of knee arthritis. This procedure can allow a person to lead a more active lifestyle without pain and aid in maintaining aerobic cardiovascular fitness. Osteotomies can also be done in other parts of the body. Please keep reading to learn more about this treatment, including the advantages and disadvantages - knee osteotomy, osteotomy compared to other procedures, recovery from joint surgery, and more.
What is an osteotomy?
Osteotomy literally means "cutting the bone." It is therefore any surgery that involves cutting and reshaping the bones. An osteotomy is often performed in active osteoarthritis patients and those with knee injuries or damaged joints. It can also be done to lengthen or shorten a bone that does not align like a normal knee joint or some other joint.
Why is it done?
Osteotomies are not only performed in older patients with arthritis pain. Many osteotomy patients are young and have damaged cartilage and bone due to repetitive stress sports. It mays also be done as part of treatment for serious knee injuries in people with fractured bones and torn ligaments. In some people with a damaged joint, osteotomy is a way to delay total knee replacement or prosthetic knees.
Types of osteotomy
Osteotomy of the hip
Hip dysplasia is a condition where the femur (thigh bone) does not have a proper fit in the socket of the hip joint in the pelvis. A surgeon can perform a hip osteotomy to reshape the hip socket for better coverage of the ball of the thigh bone.
Osteotomy of the knee joint
In patients with early-stage osteoarthritis who have healthy tissue on one side and damage on the other side of the knee joint, an osteotomy can help shift the weight off the damaged part of the joint. This will relieve pressure and pain and improve function. During a knee osteotomy, the surgeon can cut and reshape either the tibia (upper shinbone) to perform a tibial osteotomy or they can cut the lower thigh bone for a femoral osteotomy.
Osteotomy of the jaw
Sometimes there is a misalignment of the jaw. A jaw osteotomy can help move the lower jaw so that it lines up better with the bite of the teeth.
Osteotomy of the chin
A plastic surgeon can perform a chin osteotomy to make a broad chin or square jaw narrower for improved appearance.
Osteotomy of the big toe
Just a small wedge of bone can be cut during a big toe osteotomy to straighten it. This is done if the big toe is pushing into the adjacent toes.
Who is a candidate for knee osteotomy?
In general, a knee osteotomy is recommended in younger, active patients (less than 60 years old) who are not overweight, have pain on only one side of the knee, and the pain is worsened by prolonged standing and activity. Patients wishing to undergo an osteotomy on the knee joint should have good range of motion (ability to bend to 90 degrees and fully straighten the knee). This is not a treatment for rheumatoid arthritis which is an autoimmune condition. An orthopaedic surgeon will need to examine you to determine if you are a good candidate for this procedure.
Pros and cons of knee osteotomy
A knee osteotomy is performed to shift body weight from the damaged cartilage to healthy cartilage, correct poor knee alignment to mimic a healthy knee, and delay the need for prosthetic knees by prolonging the lifespan of the knee joint. Therefore, a key advantage of a high tibial osteotomy or femoral osteotomy of the knee is it preserves your own knee anatomy. The procedure can delay joint replacement surgery by many years. There are no activity restrictions after a knee osteotomy, including high-impact sports and activities.
However, a knee osteotomy has certain disadvantages as well. The pain relief is unpredictable compared to a partial or total knee replacement procedure. Also, the recovery can be long and difficult because weightbearing may not be possible right away on the operated knee. Lastly, an osteotomy can complicate knee injury treatment or later knee replacement surgery.
Given that total or partial knee replacement surgery is so successful with predictable knee pain relief, knee osteotomy is not so common anymore. However, it may still be an option for some patients with an arthritic knee who want to delay or avoid total knee replacement.
How is an osteotomy done?
You will be admitted to hospital to undergo a hip or knee osteotomy. You might need to spend a few nights in the hospital before going home (this will depend on the type of surgery). The procedure can be done using general anesthesia (you will be asleep during the surgery) or spinal anesthesia if the surgery is on the lower leg (you will be awake, but the lower part of the body below the waist will be numb). Minor procedures such as a big toe osteotomy in which a bone wedge is removed may be done using local anesthesia (only the site of the operation is numbed).
During the osteotomy procedure, the surgeon will make cuts in the skin, measure the bone with guide wires, then use a surgical saw to cut a section of bone from the healthy side of the knee. Metal plates and screws may be placed to hold the bones in place - these can be permanent or they may come out once bone healing is completed. The surgeon may also perform a bone graft to fill the empty space using a wedge of bone from the pelvis or a donated bone from a bone bank or metal hardware. 9336472605
What is a high tibial osteotomy?
A high tibial osteotomy involves removing a wedge of bone from the shinbone (tibia) below the healthy side of the knee. Closing of this wedge space leads to a straightening of the leg, bringing the healthy bones closer together and creating more space between the damaged bones on the arthritic side. This helps to relieve pain and pressure. The place where the wedge of bone is removed is held together by screws and plates. This is called a closing wedge osteotomy. The same technique can be applied to the thigh bone (femur) to correct a knock knee. An opening wedge osteotomy involves opening up the space created by removing the wedge of bone, instead of closing it, and filling the open space with a bone graft. The operation usually takes 1-2 hours.
Is osteotomy surgery painful?
You will not experience any pain during the surgery itself because it is done under anesthesia. However, once the anesthesia wears off, there can be pain. Your doctors will manage this with pain medication.
What you can expect during recovery?
Most patients go home 1-2 days after an osteotomy. Recovery from an osteotomy can take a fair amount of time with soreness and pain at the surgical site. These symptoms can be managed with pain medication.
You will need to exercise extreme caution and keep weight and pressure off the operated area for a while. For example, to avoid too much stress on the joint, you will need crutches for several months after a hip or knee osteotomy operation. Your surgeon may put you in a cast or knee brace for protection. You will also need physical therapy to strengthen your leg muscles and regain balance after the osteotomy heals.
Recovery after a jaw osteotomy will require a liquid diet for 4-6 weeks. Sometimes, the surgeon wires the jaw shut during the recovery period. Following surgery on the big toe, there will be restrictions on wearing shoes and driving for up to 6 weeks to let the osteotomy heal. Smoking and being overweight can slow the healing process.
You should follow your doctor's instructions on when to put weight on your joint and other postsurgical care to ensure an uneventful recovery. Keep all your followup appointments with your doctors and physical therapist. Most patients can resume all normal activities 3-6 months after osteotomy surgery.
Are there any risks or complications?
There are risks and potential complications with osteotomy, as with any surgical procedure. Complications can include infection, bleeding, blood clots, joint stiffness and pain, nerve injuries, blood vessel injuries, scar tissue, and failure of the osteotomy to heal as expected. Sometimes, a second surgery may be needed.
Finding a surgeon for osteotomy
The MeTime app makes it easy to find a surgeon for osteotomy procedures. You can chat with experts, share photos, get answers to your questions, and schedule a video consultation. Download the MeTime app today and learn more about how to keep your bones healthy as well as treatment options for orthopaedic conditions.
