An osteotomy is a surgical procedure in which a surgeon deliberately cuts a bone to reshape it, shorten it, lengthen it, or change its alignment. The word itself comes from Greek: “osteo” (bone) and “tomia” (cutting). While that sounds dramatic, osteotomies are among the most versatile operations in orthopedic and facial surgery, used to fix everything from arthritic knees and bunions to misaligned jaws and hip problems in children.
Why Surgeons Cut Bone on Purpose
Bones don’t always grow or heal the way they should. Sometimes a leg bows inward, putting too much pressure on one side of the knee. Sometimes a jaw sits too far forward or back, making it hard to chew or breathe. Sometimes a fracture heals at a bad angle, leaving a joint that grinds where it shouldn’t. In all these cases, the underlying problem is the same: the bone’s shape or position is causing pain, dysfunction, or progressive damage to nearby cartilage and joints.
An osteotomy addresses this by cutting the bone in a precise, planned location, then repositioning the pieces into better alignment. The surgeon holds the new position in place with metal plates, screws, nails, or staples while the bone heals. Over weeks to months, the body does what it does with any fracture: it lays down new bone tissue across the cut, eventually fusing everything into a single, realigned bone. The hardware can stay in permanently or be removed later, depending on the situation.
Common Types of Osteotomy
Knee (High Tibial Osteotomy)
This is one of the most well-known osteotomies. It’s performed on people whose knee alignment puts excessive load on one side of the joint, typically the inner (medial) compartment. Over time, that uneven pressure wears down cartilage and leads to arthritis. By cutting the top of the shinbone and adjusting its angle, the surgeon shifts your body weight toward the healthier side of the knee. The goal is to correct the alignment enough to relieve pain and delay or prevent the need for a total knee replacement. Ideal candidates are typically younger than 56, at a healthy weight, and have early to moderate arthritis rather than severe joint destruction.
The results are encouraging. About 87% of patients who undergo a high tibial osteotomy still have their natural knee 10 years later, without needing a replacement. When the procedure is combined with cartilage repair techniques, that number climbs to around 94%.
Hip (Periacetabular Osteotomy)
This procedure reshapes the hip socket to better cover the ball of the femur. It’s most commonly performed for hip dysplasia, a condition where the socket is too shallow. Without correction, the joint wears out prematurely. The surgeon makes several cuts around the socket, repositions it to provide better coverage, then fixes it in place with screws. It’s a major surgery but can preserve a young person’s natural hip joint for decades.
Jaw (Orthognathic Surgery)
Jaw osteotomies correct misalignment between the upper and lower jaws. There are three main versions. A maxillary osteotomy repositions the upper jaw when it protrudes too much or sits too far back. A mandibular osteotomy does the same for the lower jaw. When both jaws need correction, a bimaxillary osteotomy addresses them together. These surgeries improve chewing, breathing, speech, and facial symmetry.
Foot and Ankle
Osteotomies in the foot are extremely common. A bunion correction (hallux valgus osteotomy) involves cutting the first metatarsal bone and realigning it so the big toe points straight. Calcaneal osteotomies reshape the heel bone to correct flatfoot or high-arched foot deformities. These procedures can be performed through smaller incisions than in the past, and newer techniques combine bone cuts with small implants to stabilize the correction while it heals.
Arm and Wrist
Osteotomies of the forearm correct problems like a forearm bone that’s too long relative to the other (causing wrist pain), a wrist fracture that healed crooked, or excessive rotation at the shoulder. An ulnar shortening osteotomy, for example, removes a small section of the forearm bone on the pinky side to relieve pressure on the wrist joint.
Pediatric Osteotomies
Children with limb length differences or congenital bone deformities frequently benefit from osteotomies. In limb-lengthening surgery, the surgeon cuts the bone of the shorter leg and applies a device that gradually pulls the two ends apart, stimulating new bone to fill the gap. For the opposite problem, the surgeon can remove a section of bone from the longer limb and secure it with a metal rod, plate, and screws. Because children’s bones are still growing, the timing and technique of these procedures require careful planning.
What Recovery Looks Like
Recovery depends heavily on where the osteotomy was performed, but the general pattern is similar across most procedures. Most patients start moving the day after surgery. For leg osteotomies, you’ll spend the first six to eight weeks on partial weight-bearing, using crutches or a walker. Full weight-bearing typically begins between eight and twelve weeks, once X-rays confirm the bone is healing properly.
Physical therapy starts early, focused first on maintaining range of motion and preventing stiffness, then gradually building strength. For lower-limb osteotomies, returning to sports or high-impact activities generally takes six to twelve months. Jaw osteotomies have a different recovery path, with a soft-food diet for several weeks and gradual return to normal chewing as the bone heals.
The hardware used to hold the bone in place (plates, screws, staples) often stays in permanently. Ankle screws are sometimes removed earlier, between 6 and 12 weeks, before full weight-bearing begins. In other locations, hardware removal is only necessary if it causes symptoms like pain or irritation.
Risks and Complications
Like any surgery, osteotomies carry risks. The most significant is non-union, where the bone fails to heal across the cut. In one large study of forearm osteotomies, about 8% of patients developed non-union, and another 15% experienced delayed healing that eventually resolved. About 23% reported hardware-related symptoms like pain or irritation at the plate or screw site, and roughly 1 in 5 patients needed a follow-up procedure.
Infection rates are generally low, around 1 to 2% for deep infections. Other potential complications include nerve or blood vessel injury near the surgical site, blood clots, and overcorrection or undercorrection of the alignment. Undercorrection is a particular concern in knee osteotomies, where failing to shift the weight-bearing axis far enough is associated with a significantly higher failure rate.
Who Is a Good Candidate
Osteotomies work best for people who are young and active enough that preserving their natural joint is worth a longer recovery. For knee osteotomies, the ideal patient has early arthritis limited to one side of the joint, good range of motion, and a healthy body weight. For hip osteotomies, the patient is typically a young adult with dysplasia but still-intact cartilage. For jaw surgery, the patient has a measurable skeletal discrepancy that braces alone can’t fix.
The common thread is that an osteotomy is usually a joint-preserving strategy. It buys time by correcting the mechanical problem that’s causing damage, rather than replacing the joint entirely. For the right patient, that can mean decades of additional use from their own bones and cartilage.