Osteotomy: Who is a Good Candidate for Osteotomy & On Which Bone or Joint is Osteotomy Performed?
Osteotomy is a surgery in which bone is either added or removed from the affected joint. So, basically osteotomy is any surgery that cuts and reshapes your bone. The idea is to shift the weight from the damaged portion of a joint to an area where there is more healthy cartilage. This procedure is advised to patients with osteoarthritis. The patient doesn’t have to be very sick or old to have an osteotomy. Many young people have this surgery to postpone the hip/knee replacement surgeries for many years.
What is Osteotomy?
Osteotomy is a bone-realignment to shift weight-bearing away from the damaged part. This is a surgical procedure that involves bone cutting where the surgeon removes a wedge of bone near the joint which is affected. The idea is to shift the weight from the damaged portion of a joint to the healthier portion of the joint. This surgery is more relevant to people who want to postpone the knee surgery; particularly, if they are too young and active. Thus, the patient doesn’t have to be sick or old to have an osteotomy. Knee osteotomy is most common in people younger than 60 and are active.
When most patients think of joint surgery, they only think of total joint replacement. Osteotomy is a procedure that more and more people should know about.
Who is a Good Candidate for Osteotomy?
Generally, people who are below 60 years, active, and overweight are considered to be appropriate for the procedure. If the patient has uneven joint damage, deformity that is correctable, and has no signs of inflammation, he/she is a good candidate.
On Which Bone or Joint is Osteotomy Performed?
This Osteotomy procedure is used for many bones and joints. Most commonly in the following joints:
- Hip Joint: A hip osteotomy is a surgical procedure in which the bones of the hip joint are cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the weight-bearing area of the joint, followed by reconstruction of the joint in a more normal position.
- Knee Joint: In osteoarthritis-affected knee, the damage is typically more significant on the inner portion of the knee. With knee osteotomy the surgeon aims to change the weight-bearing side of the knee by the surgery. This surgery will tilt the body weight towards the healthier section of the cartilage.
- Spine: Spinal osteotomies are often used as part of a spinal reconstructive procedure to achieve spinal balance, stability and correct spinal alignment. Bone is cut in part of the vertebral segment and then removed to realign the spine in proper positioning. This surgery is an option when nonsurgical treatments fail to relieve pain symptoms.
- Jaw: Jaw osteotomy corrects irregularities of the jaw bones and realigns the jaws and teeth to improve the way they work. Making these corrections may also improve your facial appearance.
- Big Toe: Big toe is sometimes misaligned and starts jamming into other toes. A segment of bone can be removed from your big toe to straighten it.
- Chin: Chin osteotomy is basically done to narrow a broad or square chin.
Preparing for Osteotomy Surgery
Once your surgeon decides that you are a suitable candidate for Osteotomy surgery, it becomes important to follow the advices given by the doctor before the Osteotomy surgery. These may include:
If you smoke, you must stop smoking at least two weeks prior to the Osteotomy surgery and must not smoke until three months after the surgery. This will help you with a faster recovery post Osteotomy and less chances of infection.
If you have a heart condition and are on drugs like warfarin, you must understand clearly how to take medications before, during, and after the Osteotomy surgery. As, these drugs inhibit blood clotting and you may need to stop them to stop bleeding during the surgery.
In case of general anesthesia, you will be instructed about fasting and drinking water the day prior to Osteotomy surgery. You must follow these instructions to avoid vomiting.
How is Osteotomy Performed?
Various anesthesia options will be discussed with you by your doctor. A general anesthesia may be recommended to many people undergoing Osteotomy. If your Osteotomy surgery is performed on the lower half of your body, a spinal anesthesia may be recommended to numb your body below the waist area. This allows you to stay awake during the surgery. For surgeries like toe osteotomy, only local anesthesia may be given. Your doctor knows which one will suit you the best.
Basically, the Osteotomy procedure involves realignment of the weight-bearing line. At the time of the osteotomy, the surgeon will make a small cut in your skin. Special guide wires are then used to measure your bone and then a section is taken out using a special surgical saw. This cut is filled. This is done in different ways. Tiny screws and metal plates are often used to hold the bones together. They are sometimes permanent and can be taken out in some cases. A bone graft is also used by surgeons which can be taken from your pelvis or some bone bank. These are then secured with a metal hardware. Depending on the type of Osteotomy surgery, you may need to spend a few nights in the hospital.
What to Expect After the Osteotomy Surgery?
Once you are out of anesthesia, you will be encouraged to walk within few hours. This helps the blood flow and reduce the risk of DVT (deep vein thrombosis). You will be given pain relief in the first 48 hours at the hospital. At home, over-the-counter pain relief can be used as required for the next few days. Anti-inflammatory tablets are avoided during osteotomy.
After a femoral osteotomy, you will need to use crutches or knee brace for four-six weeks. Physical therapy, leg-strengthening exercises, and walking are part of the full rehabilitation program. While some surgeons predict that a return to full activities is possible after 3 to 6 months, others claim it may take up to a year to adjust to the corrected position of the knee after knee osteotomy.
Complications After the Osteotomy Surgery
Very few patients experience complications after an osteotomy; however, it is crucial to know what to look after and when to contact your surgeon. Each type of osteotomy comes with different sets of risks. In general, you must see or call your doctor in the following cases:
- If the pain does not go away for any days.
- If you get fever and feel unwell.
- If the surgery point becomes swollen, or the wound oozes or bleeds.
- If there is severe discomfort in the lower legs which can be a sign of deep vein thrombosis.
- If you have any issues with the anesthesia.
- If there is any kind of joint stiffness.
- If you feel your bones did not heal as expected.
For a selected group of people over 60 years who are suffering from knee arthritis, in particular, knee osteotomy has potential advantage over knee replacement. The reason for this is the actual knee joint is preserved.