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What Is an Osteotomy?

Joint Surgery Option

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Updated March 26, 2012

When conservative treatments for osteoarthritis, or other types of arthritis, fail to satisfactorily relieve pain and restore function to the affected joint, it may be time to consider joint surgery. But, which surgical option should you consider? Which surgical procedure would most effectively relieve your pain and improve mobility?

It's best to learn about the various types of joint surgery and understand your options. When most patients think of joint surgery, they think of total joint replacement. But, there are other procedures you should know about. There is arthroscopic surgery, hip resurfacing, arthrodesis (fusion), minimally-invasive replacement for the hip and knee, unicompartmental knee surgery, and, of course, osteotomy of the knee or hip. Here, we will concentrate on osteotomy.

Osteotomy Explained

Osteotomy is a surgical procedure that involves bone-cutting. The surgeon removes a wedge of bone located near the damaged joint. The procedure is supposed to cause a shift of weight from the area where there is cartilage damage to an area where there is more normal or healthy cartilage.

In osteoarthritis, damage is typically more significant on the inner portion of the knee. With knee osteotomy for osteoarthritis of the inner knee, the surgeon removes bone from the outside of the lower leg bone near the knee. As a result, the patient tilts their body weight towards the outer side and away from the inner damaged cartilage. If an osteotomy is performed for osteoarthritis of the outer knee, the procedure is reversed and bone is cut from the inner side of the lower leg near the knee.

During the osteotomy procedure, the surgeon also reshapes the tibia (shinbone) or femur (thighbone) to improve the alignment of the knee.

Ultimately, the procedure allows weight to be distributed more evenly across the joint cartilage. Osteotomy surgically repositions the joint, realigning the mechanical axis away from the damaged cartilage. Once the wedge of bone is removed, the surgeon brings the bones that remain together and uses pins or staples to secure them. An immobilization cast or internal plates are also sometimes used for stability.

Who Is a Candidate for Osteotomy?

Generally, people who are under 60 years old, active, and overweight are considered appropriate candidates for osteotomy. The patient must also have:

  • uneven joint damage
  • deformity that is correctable
  • no signs of inflammation

The Benefits of Osteotomy

Deciding what surgical procedure to undergo isn't always simple or clear. Knowing what to expect as an end result can help.

Pros:

  • relieves pain
  • may delay progression of osteoarthritis
Cons:
  • may cause the joint to not appear symmetrical
  • may leave total joint replacement as an eventuality

It's also important to realize that total joint replacement after osteotomy is more challenging for the surgeon. Usual surgical complications are possible with osteotomy as well.

Recovering from Osteotomy

Depending on the complexities of the procedure and the strength of the individual patient, crutches are needed for between 1 and 3 months. Patients may also have a cast or splint for 4 to 8 weeks. Physical therapy, leg-strengthening exercises, and walking are part of the full rehabilitation program. While some surgeons predict that a return to full activities is possible after 3 to 6 months, others claim it may take up to a year to adjust to the corrected position of the knee after knee osteotomy.

Sources:

Osteotomy and Unicompartmental Knee Arthroplasty. American Academy of Orthopaedic Surgeons. February 2001.
http://orthoinfo.aaos.org/topic.cfm?topic=A00354

Osteotomy for Osteoarthritis. PeaceHealth. April 20, 2007.
http://www.peacehealth.org/xhtml/content/surgicaldetail/hw125548.html#hw125550

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