What is Osteotomy?
Osteotomy, or bone cutting, is a method in which a surgeon takes out a wedge of bone near a injured joint. This transfers weight from an area where there is damaged cartilage to an area where there is more or healthier cartilage.
Candidates for Osteotomy
This procedure is ideal for those who have x-rays showing involvement of only one side of the knee joint, significant pain and disability, as well as the ability to cooperate with physical therapy and rehabilitation.
The patient will have to go through physical examination and give the doctor a complete medical history. When rehabilitation or other treatments are ruled out and surgery is necessary, the doctor must evaluate for three factors: pain, instability and knee alignment. Osteotomy is proposed if misalignment is a factor. It must be ascertained whether the instability is connected to misalignment and not to other sources like ACL injury.
A diagnostic arthroscopy, examination of the knee joint with a long tube connected to a video camera, is normally done before all knee osteotomies. The cartilage surfaces are examined for degenerative or late-stage arthritis. Also, magnetic resonance imaging (MRI) is helpful in evaluating any intra-articular pathology such as bone chips, padding tears or injuries to ligaments.
The Osteotomy Procedure
In an osteotomy, the surgeon cuts the bone and then reorients it. There are two basic types of osteotomies: closing wedge, where a wedge of bone is taken out to modify the alignment of the bone; and opening wedge, where bone is gapped open on one side to realign the bone. The surgeon will select which treatment to perform, depending on the kind of deformity and the site of your osteotomy. As soon as the bone is cut and then realigned, your surgeon may opt to use metal plate and screws to hold the bones in the new position.
Recovery depends on the surgical technique plus the strength and motivation of the patient. A cast or splint may reduce movement of the joint for 4 to 8 weeks. You will begin physical therapy instantly, even if you are in a cast or splint. When the cast is removed, you can put your full weight on the joint 10 to 12 weeks subsequent to the surgery. It may take up to a year for the knee to completely adjust to its fixed position.
Risks associated to osteotomy include failure of the bones to heal or failure to heal appropriately, blood clotting, bleeding in the joint, inflammation of joint tissues, nerve damage, or infection.
What is the purpose of an osteotomy?
Doctors opt for osteotomy if destruction of the knee cartilage largely affects a single disc of cartilage: the disc (meniscus) either on the inner part or on the outer part of the knee joint. Osteotomy is a suitable treatment for younger, active people with osteoarthritis who can delay a total joint replacement.
How effective is osteotomy?
If the amount of correction required to align the knee is somewhat small, osteotomy is effective in stabilizing the knee and alleviating pain symptoms in approximately 90% of cases.
Who is not a good candidate for a knee osteotomy?
As a rule, patients should not consider this surgery if they have:
- Prevalent arthritis of the knee (not confined to one side)
- Unsteadiness of the knee or tibial subluxation
- Substantial limitations of knee motion
- Such a noteworthy deformity, it would be hard to correct
- Inflammatory arthritis (such as rheumatoid arthritis)
Are there complications in this procedure?
Although complications are odd, there is a minor probability of infection or blood clots. There is also a very low stake of the bone not healing accurately, a nerve or artery being cut at some point in the surgery, or poor skin healing.