Osteotomy or “bone cutting” removes or adds a section of bone near a damaged joint. This shifts the weight away from the roughened and worn cartilage to an area with healthier cartilage, temporarily relieving the pain. When cartilage is healthy, it allows the bones of the thigh and shin to move together effortlessly in the knee. If the cartilage has been damaged, it causes the bones to rub against each other. The osteotomy procedure is typically performed on the knee for younger patients who wish to postpone joint replacement surgery or for those whose arthritis only affects one side of the knee.
Often performed as an arthroscopic procedure, osteotomy is successfully used to treat osteoarthritis and other forms of arthritis after conservative treatments have failed. When the problem is located on only one side of the knee, the knee may begin to lean either inward or outward. The procedure helps to shift the weight from the damaged area to an area with healthier cartilage. Once the bone has been removed, the remaining ends are pinned or stapled together and immobilized with a cast or internal plate to ensure proper healing.
The osteotomy procedure is ideal for patients with uneven joint damage and a correctable deformity. Most patients are under the age of 60 and maintain an active life. It is often effective in relieving pain and slowing the progression of osteoarthritis, although it is likely that patients will eventually need joint replacement some 10 to 15 years after undergoing this procedure.
Dr. Williams will most likely require X-rays, a CT scan or another imaging test of your knee to determine whether osteotomy is the best type of procedure for your condition. These images can also help the surgeon plan for the amount of correction that will be necessary if he or she is going to perform an osteotomy.
The best candidates for an osteotomy are usually between the ages of 40 and 60, are at a healthy weight and lead an active lifestyle. In most cases, they are only experiencing pain on one side of their knee, and have no pain under the kneecap. Pain is predominantly initiated by physical activity or by standing for long periods of time.
The Osteotomy Procedure
When undergoing an osteotomy, you will receive either general or regional anesthesia. This surgery typically takes one to two hours to perform. Dr. Williams will make an incision in the area that is affected by the condition. The procedure either involves the shinbone (tibia) or thighbone (femur), but the shinbone is more common.
During a tibial osteotomy, a wedge of bone is either added or removed to the tibia to realign the knee joint, relieving pain and restoring the balance of the knee. An opening wedge osteotomy involves an incision in the medial side of the knee to place a bone graft into the tibia. The material used for the bone graft is usually taken from your own pelvic bone, but if that’s not possible it can come from a bone bank. The graft is held in place with a metal plate or pins. A closing wedge osteotomy involves an incision on the lateral side of the knee and the removal of a small wedge of the tibia bone. The two remaining ends are then reattached, using a metal plate or pins to secure them correctly.
Some patients will require a hospital stay for one to two nights after undergoing an osteotomy. Crutches are recommended to reduce the weight bearing load on the affected knee and allow it to heal properly. Additionally, a cast or splint may be necessary to keep the joint immobilized for four to eight weeks following surgery.
Patients will need to take part in physical therapy and rehabilitation after the osteotomy procedure as well. These exercises will focus on strengthening the muscles of the thighs, increasing the range of motion in the knee and improving overall balance. Most people can usually return to all regular activities after three to six months post-surgery.
Risks of Osteotomy
Osteotomy is considered a very safe procedure that has few complications associated with it. However, there are risks to having any type of surgery performed. Some of the risks of osteotomy include blood clotting, bleeding within the joint, failure of the bones to heal completely, nerve damage, infection and joint tissue inflammation.