If you are young and have been diagnosed with osteoarthritis, your physicians may have recommended an osteotomy. This surgery helps to restore the normal mechanical joint axis of a
damaged joint and save it from joint replacement surgery, especially at a younger
age. Should you have an osteotomy and is it safe? Read on to learn more.
An osteotomy is a surgery whose purpose is to realign the bones by cutting the bone.
Osteotomy is performed because the joint mechanical axis is deviated from normal and on one side of the joint there is narrowing of the joint space.
Osteotomy can delay the joint replacement procedure, relieve joint pain, and increase joint function.
Osteoarthritis in the knee joint is one of the main reasons to perform knee osteotomy.
Serious complications are quite rare in osteotomy however, there is risk of nonunion, infection, subluxation, and instability.
What is an osteotomy?
An osteotomy is a surgery whose purpose is to realign the bones, for example, the tibia and thigh. During this surgery, the bones are cut and sometimes bone tissue is added to the cut area, depending on the condition and alignment of the joint. Osteotomy is performed because the joint mechanical axis is deviated from normal and on one side of the joint there is narrowing of the joint space.
The narrowing of the joint space often appears because of osteoarthritis, which causes joint pain and functional disorders. For example, knee osteoarthritis causes knee varus or knee valgus deformity and increases loading on the medial or lateral side of the knee. To save the knee joint, osteotomy, and collagen membrane insertion are performed, which can delay the joint replacement procedure for 20 years. Osteotomy relieves joint pain, increases joint function, preserves joint proprioception, and increases rapid recovery of joint function.
Types of osteotomies
There are various types of osteotomies including:
- Spinal. These osteotomies fix spinal deformities caused by different diseases. There are a variety of spinal osteotomies that mainly depend on the cause, type, and apex of deformity.
- Elbow. This osteotomy can fix elbow joint-related health issues, such as a contracture or other abnormalities that cause narrowing of the joint space.
- Femoral. Femoral osteotomy can treat developmental or degenerative hip diseases.
- Knee. It can treat degenerative knee joint disease.
- Foot. Osteotomies are performed on the big toe, fifth toe, and foot.
Knee osteotomy is the most common condition among the types of osteotomy.
Surgery for anti-varus deformation: high tibial osteotomy
Medial knee compartment osteoarthritis and medial space narrowing make up 74% of patients with knee osteoarthritis. In this case, unloading medial compartment high tibial osteotomy (HTO) and proximal fibular osteotomy surgeries are performed. There are a variety of HTO techniques, which depend on your individual situation and surgeon's decisions.
What is important to know before HTO surgery?
The age of the patient and functional requirements are important factors before HTO surgery. The younger the age, the higher the demands to preserve the joint. HTO surgery is recommended for patients <60 years old.
Moreover, the postoperative consequences are better when the degree of varus deformity is more than 5° according to special calculations that surgeons do from your longitudinal MRI photo.
The last factor is disease progression. The more severe the subchondral bone abrasion, the less satisfaction the patient gets.
Surgery for anti-valgus deformation: distal femur osteotomy
The less common surgery is to correct the lateral side of the knee joint. About 16% of knee arthritis cases consist of valgus deformity, which means that the lateral side of the knee is loaded more than the medial side. The reasons for this condition vary from meniscus injury to obesity. Distal femur osteotomy (DFO) is the surgery used to treat lateral osteoarthritis. During this surgery, the femur is the bone that should be corrected.
According to research where people reported their satisfaction before and after osteotomy, all patients reported less pain, improved knee function, and quality of life regardless of different osteotomy techniques.
How successful is osteotomy?
Serious complications are quite rare in osteotomy. However, the rate of surgery nonunion, infection, subluxation, and instability range from 3 to 30%.
The failure of the procedure can range from 15 to 52%, however, there are different categorizations in the literature about failure. Failure can consist of an abnormal joint line that can cause subluxation. Two studies found the subluxation rate was 30%.
Nevertheless, the biggest failure is the requirement of total knee replacement. About 10% of patients required total knee replacement after HTO, regardless of stage of follow up. After 10 years of follow up, only 26 to 33% of patients needed total knee replacement.
Should I have an osteotomy?
Osteotomy is a primary choice for young patients, less than 60 years of age, who have been diagnosed with osteoarthritis in order to preserve the joint and avoid joint replacement. Osteotomy not only preserves the joint but also decreases pain, increases function, and allows the patient to get back to normal life quicker. However, each of us is different and before you make a decision, discuss it with your doctor.
Is osteotomy a major surgery?
High tibial osteotomy is a major procedure because it is technically difficult to perform. It is important that an experienced surgeon performs the osteotomy to optimize results. Moreover, there is quite a long healing period that mostly depends on other surrounding tissue damage.
When can I have full weight bearing on my leg after osteotomy?
It is very important to start proper rehabilitation after osteotomy. Twenty-four hours after knee osteotomy, the patient can fully stand on their legs. Weight-bearing during walking should start from 44–88 lbs on the operated leg and gradually increase. About 4 to 6 weeks after surgery, the patient can fully bear weight on the operated leg. However, it is important to follow the surgeon’s instructions.
The first thing that you need to start is the passive motion of your knee joint. Active motions are not allowed. The passive flexion of your knee joint can be started 24 hours after surgery when you place your leg in a special passive motion apparatus and progressively increase the range of motion.
The intensive rehabilitation starts after 4 weeks after surgery, and the patient can return to normal activity and daily life 4 to 6 months after surgery.
Nevertheless, a rehabilitation plan must be adopted according to your individual situation. Consult with your surgeon and physical therapist, as well as your other physicians, for a comprehensive, personalized plan.
- Cochrane Database of Systematic Reviews. Osteotomy for treating knee osteoarthritis.
- European Journal of Orthopaedic Surgery and Traumatology. Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature.
- Knee Surgery, Sports Traumatology, Arthroscopy. Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis.
- EFORT Open Reviews. Spinal osteotomies: Indications, limits and pitfalls.
- Orthopaedic Surgery. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis.