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Osteotomy – Bone Correction Explained

An osteotomy is a surgical procedure in which a bone is precisely cut to correct misalignment, redistribute joint load, and reduce pain.

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Things worth knowing about "Osteotomy"

An osteotomy is a surgical procedure in which a bone is precisely cut to correct misalignment, redistribute joint load, and reduce pain.

What is an Osteotomy?

An osteotomy (from Greek osteon = bone and tome = cut) is a surgical procedure in which a bone is deliberately cut in order to change its alignment, angle, or shape. The goal is to correct deformities, relieve pressure on joints, and reduce pain. Osteotomies are performed in both adults and children, depending on the underlying condition.

Indications

An osteotomy may be recommended in several clinical scenarios:

Osteoarthritis: Redistributing load away from a damaged joint compartment, especially in the knee or hip
Bone malalignment: Correcting bow legs (varus deformity) or knock-knees (valgus deformity)
Congenital bone deformities: Such as hip dysplasia or clubfoot
Post-traumatic deformities: Correction of malunited fractures
Orthognathic surgery: Correcting jaw and bite misalignments

Types of Osteotomy

Corrective Osteotomy

A corrective osteotomy is used to straighten a bone that has grown or healed in an abnormal position. The bone is cut at a precisely planned location, repositioned, and fixed with metal implants such as plates, screws, or staples.

Realignment Osteotomy

A realignment osteotomy shifts the mechanical axis of a limb to redistribute forces across the joint. A common example is the high tibial osteotomy (HTO), which is used to offload the medial compartment of the knee in cases of medial osteoarthritis.

Shortening and Lengthening Osteotomy

These procedures aim to alter bone length. In a shortening osteotomy, a segment of bone is removed. In a lengthening osteotomy, the bone is gradually distracted using an external fixator, for example using the Ilizarov technique.

Opening-Wedge and Closing-Wedge Osteotomy

In an opening-wedge osteotomy, a wedge-shaped gap is created in the bone and filled with bone graft or a synthetic implant. In a closing-wedge osteotomy, a bone wedge is removed and the bone ends are compressed together.

Surgical Procedure

An osteotomy is typically performed under general or regional anesthesia. After a skin incision is made over the affected bone, it is cut at the pre-planned site using a surgical saw, osteotome, or laser. The bone is then repositioned and held securely in place with metal implants. The wound is closed in layers at the end of the procedure.

Recovery and Rehabilitation

Careful postoperative management is essential for a successful outcome:

Partial weight-bearing on the operated limb for several weeks
Physiotherapy to restore range of motion and muscle strength
Regular X-ray follow-up to monitor bone healing
Removal of implants after complete bone consolidation, depending on the technique and location

Full bone healing and return to normal loading typically takes between three and six months, depending on the type of procedure, the age of the patient, and bone quality.

Risks and Complications

As with any surgical procedure, osteotomy carries potential risks:

Infection of the wound or bone
Delayed bone healing or nonunion (failure of the bone to consolidate)
Nerve or vascular injury
Implant failure or loosening
Deep vein thrombosis or pulmonary embolism
Loss of correction or unsatisfactory alignment result

Outcomes and Prognosis

With careful patient selection and proper surgical technique, osteotomy generally provides good to excellent long-term results. Younger and middle-aged patients with early-stage arthritis and correctable malalignment benefit particularly well from this procedure, as it can delay or even avoid the need for a total joint replacement for many years.

References

Morrey, B. F. (Ed.): Joint Replacement Arthroplasty, 4th edition, Lippincott Williams & Wilkins, 2011.
Staubli, A. E. & Jakob, R. P.: Open-wedge high tibial osteotomy: a new instrument for accuracy control. Knee Surgery, Sports Traumatology, Arthroscopy, 2010; 18(2): 164–168.
Paley, D.: Principles of Deformity Correction, Springer Verlag, 2002.

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