Osteotomy is a specialized orthopedic procedure involving the precise cutting and reshaping of bone tissue. Derived from the Greek words osteo (bone) and tome (cutting), this surgery corrects deformities and realigns joints damaged or misaligned due to congenital issues, trauma, or degenerative conditions. It is often employed as a joint-preserving measure, particularly for younger patients, to delay or potentially prevent the need for a total joint replacement.
Understanding Bone Realignment Surgery
The fundamental purpose of an osteotomy is to shift the mechanical load-bearing axis of a joint from a damaged section to a healthier one. This redistribution of stress reduces pain and slows the progression of cartilage wear. The surgeon achieves this by creating a controlled break in the bone near the affected joint and adjusting the bone’s angle.
Two primary technical methods exist for performing this bone adjustment. A closing wedge osteotomy involves removing a wedge-shaped section of bone, allowing the remaining segments to close the gap. An opening wedge osteotomy involves making a cut and distracting, or opening up, the bone to create a wedge-shaped gap.
For the opening wedge technique, the created space is often filled with a bone graft or a synthetic spacer to stabilize the correction and promote healing. Both methods realign the limb, but the choice depends on the specific joint, the degree of correction needed, and the surgeon’s preference. Once the new alignment is secured, the bone is fixed in position using specialized surgical hardware.
When Osteotomy is Recommended
Osteotomy is reserved for active patients experiencing joint pain with localized, rather than widespread, damage. It is most commonly recommended for individuals under the age of 60 with early-stage, isolated arthritis, known as unicompartmental osteoarthritis. Correcting the alignment preserves the patient’s natural joint function and relieves symptoms.
A major indication for osteotomy is the correction of mechanical axis deformities, such as bow-legged (varus) or knock-kneed (valgus) alignment. These malalignments place uneven stress on the joint and, if left untreated, accelerate cartilage breakdown. The procedure effectively realigns the limb to distribute weight more evenly.
For patients too young for a total joint replacement—which has a finite lifespan—an osteotomy can delay the need for a prosthetic joint by many years. This joint-preserving intervention aims to extend the life of the patient’s native anatomy. Success hinges on the damage being confined to one area, leaving a healthy section of the joint available to assume the weight-bearing load.
Specific Types of Osteotomy
In the knee, the most frequent procedures are the High Tibial Osteotomy (HTO) and the Distal Femoral Osteotomy (DFO). HTO involves the shinbone (tibia) and corrects bow-legged alignment, shifting the load away from the inner (medial) compartment. Conversely, DFO involves the thigh bone (femur) to correct knock-kneed alignment, redistributing force away from the outer (lateral) compartment.
Hip osteotomies address structural issues like developmental dysplasia, where the socket (acetabulum) is too shallow or poorly oriented. A Periacetabular Osteotomy (PAO) is a complex procedure that frees the hip socket from the pelvis so it can be rotated for better coverage of the femoral ball. Another option is a femoral osteotomy, which corrects deformities in the upper thigh bone to improve its fit within the socket.
In the foot, osteotomies are common for correcting Hallux Valgus, or a bunion. Techniques like the Chevron, Scarf, and Akin osteotomies involve precise cuts in the metatarsal or toe bone to realign the big toe. These procedures correct the painful angulation and restore normal foot mechanics.
The Surgical Day and Immediate Recovery
On the day of surgery, the patient receives either general anesthesia or a combination of regional and sedation anesthesia, such as a spinal block. The surgeon makes the precise bone cut, realigns the segments, and secures the new position using internal fixation hardware. This hardware, typically specialized metal plates, screws, or staples, provides rigid stability while the bone heals.
The operation typically lasts between 60 to 120 minutes. Following the procedure, patients are monitored in a recovery unit before being transferred to a hospital room. The hospital stay usually ranges from one to three days, with hip osteotomies often requiring a slightly longer stay than knee procedures.
Immediate post-operative care focuses on managing pain with medication and controlling swelling with ice and elevation. Physical therapy usually begins within the first day or two, initiating gentle range-of-motion exercises. Patients are fitted with a brace or instructed on the use of crutches before being discharged home.
Long-Term Rehabilitation and Results
The long-term success of an osteotomy depends on achieving complete bone healing in the new alignment. For major weight-bearing bones like the tibia or femur, the initial healing phase requires a period of strict non-weight bearing, typically six weeks, to protect the surgical site. The patient must use crutches or a walker during this time.
Once X-rays confirm sufficient bone healing, a gradual transition to partial and then full weight-bearing begins under physical therapist guidance. Physical therapy is paramount, focusing on regaining full range of motion, rebuilding muscle strength, and restoring balance and gait. Full functional recovery, allowing a return to most daily activities, usually takes between six and nine months.
The longevity of a successful osteotomy is significant; studies show that approximately 70% of knee osteotomy patients still have a well-functioning native joint ten years after the procedure. This pain reduction and improved function allows younger, active patients to maintain an athletic lifestyle, successfully delaying the necessity of a total joint replacement.