An osteectomy is the purposeful removal of bone tissue from the body. The term is derived from Greek, combining osteo- meaning “bone,” and -ectomy meaning “surgical excision” or “removal.” This operation is distinctly different from an osteotomy, which refers primarily to the cutting or dividing of a bone without necessarily removing a section.
The Definition of Bone Removal in Surgery
The material physically removed during an osteectomy is the calcified tissue that makes up the skeletal structure. This can include the dense outer layer, known as the cortical bone, which provides structural strength to the bone shaft. It may also involve the spongy, porous tissue found inside, called cancellous bone, which contains bone marrow.
Advanced planning and specialized tools are required to ensure accuracy and control during the removal process. Surgeons often use guide wires and templates mapped from pre-operative imaging to define the exact lines of excision. The physical removal is then performed using high-speed oscillating saws, surgical burrs for grinding, or sharp, scoop-like instruments called curettes. The tissue taken out is carefully managed and sent for pathological analysis if disease or tumor is suspected.
Reasons for Performing an Osteectomy
The decision to perform an osteectomy is always rooted in a medical necessity to restore function, relieve pain, or eliminate diseased tissue. One frequent reason is the correction of a bony deformity, such as the misalignment of a joint. For instance, removing a wedge of bone from the shinbone (tibia) can realign an arthritic knee joint, shifting the weight-bearing load from a damaged area to a healthier section of cartilage.
The procedure is also performed to excise pathological tissue, which may include benign or malignant bone tumors (neoplasms). Similarly, an osteectomy is used to treat severe bone infections, known as osteomyelitis, where non-viable or infected bone tissue must be surgically debrided. The surgeon removes the dead bone until healthy bone, identifiable by punctate bleeding, is reached.
Another common indication is the alleviation of joint impingement or restricted movement. This often involves shaving down or completely removing small, abnormal bone growths called osteophytes, or bone spurs, that have developed in response to arthritis or injury. The removal of these spurs frees up the joint space, reducing friction and pain that limit mobility.
Categorizing the Extent of Bone Removal
The structural method of bone removal determines the classification of the osteectomy, reflecting the amount and shape of the tissue excised. A wedge osteotomy is a common technique where a precisely measured, triangular piece of bone is removed, allowing the remaining bone ends to be brought together. This “closing wedge” technique is frequently used to correct angular deformities in the leg, facilitating bone-on-bone healing without the need for a bone graft.
A more extensive procedure is the segmental osteectomy, which involves the removal of an entire section of bone, leaving a distinct gap or defect. This radical excision is necessary for the removal of aggressive tumors or areas of widespread chronic infection. The resulting bone defect often requires immediate reconstruction, using either a bone graft taken from the patient or a donor, or by filling the space with specialized bone cement.
When removing diseased tissue from a cavity within the bone, such as a cyst or localized infection, the surgeon may perform curettage or saucerization. Curettage is the scraping out of the lesion, leaving a defect that may be filled. Saucerization involves excising the outer shell of bone to create a shallow, saucer-shaped depression that eliminates the diseased tissue and promotes healing from the base outward.