Osteotomy is a surgical technique used to correct alignment or malunion in a bone. It may be used to fix a broken bone that healed incorrectly, remove part of a bone, or cut open a bone.
Healthcare professionals use osteotomy during surgeries to correct joint concerns or injuries. It’s also used in cases when bones like those in the legs are different lengths.
People of all ages can have this type of procedure.
Read on to learn more about what an osteotomy is, how it’s done, and what to expect if you or someone you love has this surgery.
Osteotomy literally translates to “cutting of the bone.” It’s a surgical procedure in which one of your bones is cut to remove or reshape part of it.
You might need an osteotomy for a few reasons. One of these is referred to by healthcare professionals as a structural malformation.
An example of this is a severe difference in the structure of a person’s jaw that creates a pronounced overbite or underbite. You could have an osteotomy for cosmetic reasons, such as to change the appearance of your face or jaw, or for medical reasons, such as to correct issues with breathing, eating, or speaking caused by the malformation.
Another common reason for an osteotomy is to correct damage from an injury or chronic deterioration.
Osteoarthritis is a common reason for osteotomy of the leg bones, particularly at the hip or knee joints. By cutting and reshaping bone segments, a surgeon can relieve pressure from areas of the joint where you are experiencing pain and damage.
In some cases, a surgeon may perform an osteotomy of the leg or arm joints to correct a difference in limb length.
There are several types of osteotomy, and the one you choose depends on factors like:
- which bone is affected
- why you are having the procedure done
- your overall health
- your surgical goals
Ultimately, your surgeon will determine the specific technique they’ll use to perform the osteotomy. Some examples of different types of osteotomy include:
- lateral closed-wedge
- medial opening-wedge
- dome osteotomy
- hemicallotasis with external fixator
Some common names for osteotomy types based on the surgical location include:
- Jaw: dentofacial osteotomy, corrective jaw surgery
- Chin: osteotomy of the chin
- Elbow: French osteotomy
- Spine: spinal osteotomy
- Knee: high tibial osteotomy during knee surgery
- Hip: McMurry osteotomy, Pauwel’s osteotomy, Salter’s osteotomy, Chiari’s osteotomy, Pemberton’s osteotomy
Before an osteotomy, a healthcare professional will perform diagnostic tests to help identify the exact location and degree of damage that needs to be repaired. Your surgeon may use imaging tests like an X-ray or CT scan to map out the affected bone and make a plan for reshaping and remodeling and damaged area.
You will also undergo general preoperative testing like blood tests to check for clotting disorders and an examination of your overall health.
Your specific preoperative instructions will depend on the procedure you are having done and the doctor performing the surgery. In many instances of orthopedic surgeries of the legs, like hip or knee osteotomy, your surgeon may recommend you take steps such as:
- improving your overall health
- losing weight
- taking a preoperative class to review types of therapy
- reviewing current medications and allergies
What to ask your doctor before an osteotomy
Before your osteotomy — as with any surgery — it can be helpful to ask your surgeon questions about how to prepare, what to expect on the day of surgery, and what your recovery will be like. Each hospital or surgical center may have its own procedures, and being prepared for what is about to happen can help relieve any anxiety about the procedure.
Some questions to ask your doctor before surgery include:
- Do I need someone to drive me to the surgery?
- When do I need to stop eating and drinking?
- Should I take my regular medications before surgery?
- What should I bring with me?
- Will I stay overnight in the hospital? If so, for how many days?
- What type of anesthesia will be used?
- How long will my surgery take?
- How big will the incision be and where will it be?
- When can I see my family after surgery?
- How will my pain be managed after my surgery?
- When will I begin physical therapy or rehab?
- What types of restrictions will I have after the operation?
- How long will my recovery take?
You will receive instructions on when to stop eating, drinking, or taking medications on the day of your surgery, as well as when to arrive at the hospital. You will be taken to a preoperative area to change into a hospital gown, and you may need to bathe in a special solution to help kill any bacteria on your skin.
Your medical team will review the surgical plan, your allergies, and any concerns you may have. A healthcare professional will place tubes called intravenous catheters or IVs so that you can receive medications during the surgery.
When the surgery begins, your surgeon will take the following general steps, with some adjustments based on the specific type of procedure:
- A healthcare professional will take you to the operative room and cover you with a sterile drape. The surgical team will confirm what is about to be done and clean the site.
- You will receive sedation, usually in the form of general anesthesia. This often requires the use of a breathing tube during the surgery that is later removed in the recovery area.
- A surgeon will make an incision through your skin and other tissues to expose the affected bone.
- They will use a surgical saw to cut and reshape your natural bone. If necessary, they may place implants or bone grafts to complete the restructuring of your bone.
- The surgeon may use plates, screws, or other hardware to secure the reconstructed bone.
- They will close the incision and the surgery will be over.
After your surgery, you are usually moved to a recovery area for close monitoring while the effects of your sedation or anesthesia wear off. If you had a breathing tube, it is usually removed in the recovery area.
Healthcare professionals will monitor you for any complications, like a drop in blood pressure or blood loss, and treat them at this time. Once your surgical team is sure you can recover safely, you will be moved to a postoperative room for roughly 1 to 2 days, until you are ready to go home. In some cases, you may elect to go to a rehabilitation facility to complete your recovery.
Your doctor will visit you after the surgery to check on your progress before discharge. Your pain will be managed by things like:
Physical and occupational health therapists may also visit you. They can assist you in standing and performing your daily tasks after surgery.
Most surgeons want you to start moving as soon as possible after your surgery. They may apply a cast or brace to aid in your recovery and protect the surgical wound as it heals.
In the weeks after you are released from the hospital, you will undergo therapy and rehabilitation that will help you get the most out of your remodeled bone. Full recovery can take roughly 3 to 6 months for knee osteotomy.
The risks of osteotomy are similar to those you would face with other surgeries, including:
Most people can resume their usual activities within 6 months of osteotomy surgery. This is the time it can take your surgical wounds and reconstructed bone to heal.
In some cases, you may require additional surgeries to completely fix the damaged area, or it could take additional time to recover if you experienced any surgical complications.
Who is a candidate for an osteotomy?
Although it depends on the specific bone, osteotomy candidates are generally people who are active, fit, and under age 60. It’s also important that there are still good areas of bone to keep and that there are no other underlying joint issues.
Will an osteotomy completely cure my condition?
An osteotomy is not always curative, as in the case of osteoarthritis. An osteotomy is often used to relieve pain and improve mobility in younger people, although a full joint replacement is usually still needed later in life.
Am I limited in how I can use the bone after surgery?
After surgery, it takes several months to heal. During this time, your doctor may recommend a reduction in the amount of weight you place on the surgical area. Throughout your recovery, you will increase your weight-bearing limit, eventually achieving full strength after 6 weeks or more in most cases.
An osteotomy is a surgery where diseased, damaged, or injured bone is cut and reshaped to improve function and reduce pain.
This is major surgery, so recovery can take several months. In the end, you may still need additional surgeries down the road — especially when it comes to knee and hip osteotomies — but this procedure may slow the progression of conditions like arthritis and extend the life of your natural bone.