Osteotomy surgery is an orthopedic procedure that is often performed to fix deformities of the bone. It is done to realign joints to minimize pain and restore function. It is commonly performed on people with knee and hip arthritis, certain spinal irregularities, or some congenital/acquired skeletal deformities. Surgeons attempt to modify the bone by shaping and cutting it so that the load bearing shifts to a more favorable position and the joints are better aligned. Understanding for types of osteotomy surgery.
What Is An Osteotomy Surgery?
An osteotomy is a surgical procedure whereby a bone is severed in order to shorten it, increase its length, or reposition it. This procedure is most commonly performed on weight-bearing joints such as the knee, hip, spine, as well as jaw and toes. The procedure is done with the aim to alleviate pain, improve movement, and postpone total joint replacement.
Why is an Osteotomy Surgery Performed?
To rectify deformities that can arise from arthritis, injury, or even congenital defects.
- To relieve overwhelming force on damaged cartilage or joints.
- To postpone joint replacement surgery, mostly in young, active patients.
- To enhance functional movement capabilities and improve joint movement.
- For the treatment of hip dysplasia, bow legs (genu varum), knock-knees (genu valgum), and spinal scoliosis.
Most Common Types of Osteotomy Surgery
Let’s categorize the major forms of osteotomy according to the specific body part involved:
- High Tibial Osteotomy (HTO)
Used for: Knee joint (especially in medial compartment arthritis)
This surgery is performed when there is misalignment in the knee such as bow leg which causes overuse of one part of the knee joint. The tibia, or shinbone, is cut and turned to shift the load to alleviate the damaged portion of the knee.
Benefits:
- Pain relief for the knee joint
- Delays total knee arthroplasty or sometimes even prevents it
- Enhancement of knee function
Common Patients:
Younger patients suffering from early-stage osteoarthritis
Individuals with bow-legged deformity
- Femoral Osteotomy
Used for: Correction of the alignment of the hip and knee joints
This procedures consists of cutting and realigning the femur (thigh bone). It is often used to address hip dysplasia, rotational deformity and certain developmental disorders.
Types:
- Intertrochanteric femoral osteotomy: Realigns femur at the level of hip joint.
- Distal femoral osteotomy: is done at the knee for knock knee (valgus) deformity.
Advantages:
- Stops progression of joint damage
- Alleviates discomfort experienced in the hip and knee joints
- Pelvic Osteotomy
Used for: Hip dysplasia and associated conditions
This procedure is performed mostly in children and young adults suffering from developmental dysplasia of the hip (DDH). The pelvic bones are remodeled to enhance the structural coverage of the femoral head by the acetabulum.
Types:
- Periacetabular osteotomy (PAO)
- Salter osteotomy
- Triple pelvic osteotomy
Goal:
- Enhance the functional and anatomical congruency of the joint.
- Avoid premature osteoarthritis of the hip joint.
- Spinal Osteotomy
Used for: Advanced kyphosis or scoliosis deformities of the spine
Spinal osteotomy consists of resection of a wedge-shaped bone from a vertebra to adjust curvature of the spine and restore normal posture.
Types:
- Smith-Petersen Osteotomy (SPO)
- Pedicle Subtraction Osteotomy (PSO)
- Vertebral Column Resection (VCR)
Best suited for:
Stiff spinal segments
Degenerative changes in the spine in older age.
- Mandibular or Maxillary Osteotomy (Jaw Osteotomy)
Used for: Surgically align jaws for orthognathic reasons.
This procedure is carried out by oral and maxillofacial surgeons for correcting misaligned jaws, underbites, or overbites. The jaw (either upper maxilla or lower mandible) is repositioned to enhance mastication, respiration, and aesthetics of the face.
Advantages:
- Restored oral function
- Enhanced symmetry of the face
- Improved airflow for patients with sleep apnea
Foot and Ankle Osteotomy
Applied to: Bunions, flat feet, and alignment problems
These operations eliminate discomfort and distortions in the bones of the foot. Noteworthy examples are:
- Chevron osteotomy: Treatment for bunions
- Calcaneal osteotomy: Treats flatfeet
- Metatarsal osteotomy: For forefoot alignment
Outcomes:
- Improved biomechanics of the foot
- Freedom from pain during ambulation and movement
Which is better – Osteotomy or Joint Replacement?
Most times, osteotomy is preferred over joint replacement, especially in younger and active individuals. While joint replacement provides more immediate relief in advanced cases of arthritis, they have a limited lifespan, reduced mobility, and restricted physical activities. Osteotomy has the advantage of conserving the natural joint, which delays the requirement for an implant.
- Conditions Treated with Osteotomy
- Osteoarthritis of the knee or hip
- Hip dysplasia
- Congenital limb deformities
- Scoliotic conditions or other spinal curvatures
- Malunited fractures
- Jaw in coordination
- Bunion deviations
Recovery and Rehabilitation Following Osteotomy Surgery
The recovery process differs for each osteotomy, however, the general guidelines are as follows:
- Hospital Stay: 2–5 days
- Initial Recovery: 6–12 weeks
- Physical Therapy: Essential for Strength and Mobility Restoration
- Weight-Bearing: Incrementally increased depending on recovery
Additional Tips for Recovery:
- Follow post-operative care instructions
- Attend all physiotherapy appointments
- Sustain a healthy body weight
- Avoid high-impact activities in the short term
Risks and Complications
While osteotomy is commonly considered safe, it still has some risks, including but not limited to:
- Infection
- Blood clots
- Nonunion or stunted healing of bone fractures
- Damage to nerves or blood vessels
- Need for additional surgery
Choosing an experienced orthopedic surgeon alleviates these risks greatly.
Conclusion
For most patients looking to avoid or delay joint-replacement surgery, osteotomy serves as a reliable solution for their joint pain and joint imbalances. The procedure allows for different types to be customized to specific joints and associated deformities, thus, providing long-term relief, improved function, and enhanced joint preservation. If you lead an active lifestyle and have early to moderate damage to your joints, consult with an orthopedic specialist to explore whether osteotomy surgery is appropriate for your condition.
