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Osteotomy Surgery in Delhi, India
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A surgical procedure with which the bone is reshaped to allow for re-alignment is called an osteotomy. This procedure helps repair a damaged joint. It can also help shorten or lengthen a deformed bone that fails to align with the joint as it should. This procedure requires meticulous planning during the recovery period. The procedure is carried out under general anaesthesia. The purpose of osteotomy differs based on the location of the affected joint
Osteotomy can be done in both young individuals and older citizens. This procedure can help postpone a hip or knee surgery for many years. In addition, it helps relieve pain and restores the function of the affected joint.
Types
Osteotomy can fix problems in many different bones and joints. For instance:
- Hip: During surgery, a doctor will reshape the hip socket to cover the hip joint's ball better
- Knee: A kneecap that is not aligned well, causing pain and can worsen with arthritis. During a knee osteotomy, either the tibia (upper shinbone) or femur (lower thigh bone) is cut and reshaped. This lowers the pressure on the injured side of the knee joint
- Spine: A wedge-shaped piece of bone taken from a section of the spine can be cut and removed to reduce a hunchback or correct a swayback
- Jaw: When the bones of the face don't align with the bite of the teeth, osteotomy of the lower jaw (mandible) can help move the jaw to a new position and change a person's aesthetic appeal. It can also be done when placing dental implants in order to alter the bone surface to accommodate the implant
- Big toe: A segment of the bone can be removed from the big toe to straighten it and prevent jamming into the other toes
- Chin: Plastic surgeons sometimes use osteotomy to narrow a broad or square chin for a better esthetic look
When is surgery needed?
Generally, people under 60 years old, active, and overweight are considered appropriate candidates for osteotomy. It is mainly done to:
- Correct the excessive angulation, rotation, or bowing of long bones
- Correct the mal-alignment of a joint that may have occurred due to malunion or deformities like coxa vara, genu varum, and genu valgum
- To relieve pain in cases of arthritis, especially of the hip and knee.
- Particular indications where osteotomy is performed for purposes other than above, e.g., McMurray's osteotomy.
Diagnosis
Specialists take a thorough medical history to assess any pre-existing medical conditions. Certain tests that may be advised are:
- Routine blood tests to rule out infections, haemoglobin level, blood group
- Liver and kidney function tests
- Urine tests
- X-rays
- CT scans
- MRI (rarely)
- Detailed assessment of heart function for elderly patients
Treatment
Osteotomy can be a complex procedure. In most cases, one needs to be admitted to the hospital. The doctor first discusses the options for anaesthesia appropriate for a given joint, and consent is obtained. For instance, the patient may choose a spinal tap for osteotomy involving the lower bones of the body (e.g., knee) so that they are awake but feel numb in the lower half of the body. Similarly, the patient may be administered local anaesthesia for minor procedures such as the toe.
Osteotomy Procedure
First, the patient is put under anaesthesia. Then, the skin is incised to access the area of bone on which the surgery has been planned. Next, special guide wires are used to measure the bone, after which a section of the bone is removed using a surgical saw.
The new, open space is filled with bone grafts or bone chips. Small screws and metal plates are used to hold the bone in place and can be taken out once the bone heals. In some cases, they are left within permanently.
The bone grafts can be allografts or autologous bone grafts taken from a bone bank or a wedge removed from the pelvis. Metal hardware can also help hold the bones in place. Once the surgery is done, sutures are placed, and the patient is sent to the recovery room. Once the patient is conscious, they are shifted to the normal room.
Who are the best candidates for surgery?
The best candidates for an osteotomy procedure are those who:
- Are relatively young - between the age group 40 to 60 years
- Are not obese
- Have mild to moderate arthritis. This condition should be affecting only one side of the knee and little to no damage on the other side.
- Good knee movements
- Experiencing significant arthritis pain brought on by activity or standing for an extended period of time
- Want to stay physically active—also, those who are willing to commit to a long post-surgical physical therapy regimen.
- Can use crutches and limit weight bearing for about 6 to 8 weeks after the surgery is performed
Who should not consider surgery?
- Osteotomy is contraindicated in patients with rheumatoid arthritis, inflammatory arthritis, or chondrocalcinosis.
- Pre-operative pain in the knee should be minimal when the patient is at rest since pain at rest may indicate that there may be an inflammatory component to treat first.
- ACL tear injuries
- Osteochondral injuries with the following conditions:
- Involvement of more than 1/3 of the condylar surface
- When the OCD lesion is more than 5 mm deep, osteotomy alone may not be sufficient to restore adequate function to the knee (in these cases, allografting should be considered)
How do you prepare for the surgery?
A complete body examination and imaging tests assist the operating doctors in preparing an appropriate treatment plan.
Medical Evaluation
A thorough medical and physical evaluation should be done before any surgical procedure.
Medications
It is essential to inform the treating orthopaedic surgeon about any ongoing medications since some medicines need to be stopped or have their doses reduced before the surgery begins. Blood thinners need to be stopped three days before surgery and two days after to control bleeding during the procedure.
Other factors to be considered are
Smoking and drinking should be stopped for a week before surgery until wholly healed from surgery. Following a well-regulated exercise regime and a nutritionally balanced diet can help faster recovery. Research says that people who smoke are more susceptible to suffering complications from joint replacement surgery than non-smokers. About 12 hours of fasting is recommended before the surgical procedure to avoid anaesthetic complications.
Possible Complications
Osteotomy is a relatively safe procedure. However, every surgery carries its own risks and possible complications. Prior to the surgery, the doctor would discuss all the measures that need to be taken to avoid any complications that may occur before, during, and after the surgery. Although the risks are too low, the most common complications of osteotomy are:
- Infection or sepsis
- Formation of blood clots
- Stiffness of the involved joint
- Injuries to vessels and nerves
- Swelling that may take longer to resolve
- Unbearable pain
- Failure of the osteotomy site to heal
Sometimes, a second surgery may be necessary, particularly if the osteotomy does not heal.
Care after surgery
- Hospital discharge: In most cases, patients can return home within one or two days after the surgery.
- Pain management: After surgery, one must take pain medications as advised by the doctor. For instance, opioids, NSAIDs
- Weight-bearing: Using crutches after the surgery helps to walk easily and conveniently. A knee brace or cast may be placed to limit the movement of the operated bones.
- Regular follow-ups are essential to assess how well the bones have healed.
- Rehabilitation exercises: During rehabilitation, a physical therapist guides with the exercises to follow to help maintain the range of motion.
All activities can be resumed 3 to 6 months after surgery.
Review
Reviewed by Dr. Karan Baveja, Senior Consultant, Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury.
Frequently Asked Questions
What is an osteotomy, and why is it performed?
An osteotomy is a surgical procedure that involves cutting and repositioning a bone to correct deformities or align the bones properly. It is performed to address conditions such as bone abnormalities, joint misalignments, and angular deformities that may cause pain, functional limitations, or joint instability.
How does an osteotomy help in correcting bone deformities?
An osteotomy helps correct bone deformities by strategically removing or repositioning a portion of the bone. This allows the surgeon to realign the bones, restore proper joint mechanics, improve weight distribution, and alleviate symptoms associated with the deformity.
Can osteotomy be used to treat arthritis?
Yes, osteotomy can be used to treat arthritis, particularly in cases where joint degeneration is localized to a specific area. By realigning the bones, an osteotomy can offload the damaged portion of the joint, reduce pain, and potentially delay or prevent the need for joint replacement surgery.
Is osteotomy an alternative to joint replacement surgery?
In some cases, osteotomy can serve as an alternative to joint replacement surgery, especially for younger or more active patients. Osteotomy aims to preserve the natural joint by repositioning the bones, redistributing forces, and improving joint mechanics, while joint replacement involves replacing the entire joint surface with artificial components.
What are the common areas of the body where osteotomy is performed?
Osteotomy can be performed in various areas of the body, including the shoulder, spine, knee, hip, and ankle. These are common sites where osteotomy is used to correct deformities, improve joint function, and alleviate pain.
How long does it take to recover from an osteotomy procedure?
The recovery time after an osteotomy procedure varies depending on the specific surgery performed, the individual patient, and the extent of the bone realignment. Generally, it can take several weeks to months for the bone to heal, and full recovery may require ongoing rehabilitation and physical therapy.
Are there any risks or complications associated with osteotomy?
Like any surgical procedure, osteotomy carries certain risks and potential complications. These can include infection, bleeding, nerve or blood vessel injury, bone nonunion, malunion, limited range of motion, and persistent pain. However, with proper preoperative assessment, surgical expertise, and postoperative care, the risks can be minimized.
Can osteotomy help in correcting limb length discrepancies?
Yes, osteotomy can help in correcting limb length discrepancies by precisely cutting and repositioning the bone to achieve equal limb lengths. This procedure is often performed in cases where there is a significant difference in leg lengths, which may cause gait abnormalities or functional limitations.
Is osteotomy an effective treatment for hip dysplasia?
Osteotomy can be an effective treatment for hip dysplasia, especially in mild to moderate cases. By reshaping the hip socket and repositioning the femoral head, osteotomy can improve joint stability, reduce pain, and potentially delay or prevent the need for hip replacement surgery.
Can osteotomy be used to correct angular deformities in the legs?
Yes, osteotomy is commonly used to correct angular deformities in the legs, such as bowlegs (varus deformity) or knock-knees (valgus deformity). By carefully cutting and realigning the bones, osteotomy can restore proper leg alignment, improve joint mechanics, and alleviate associated symptoms.
Is osteotomy a suitable treatment option for scoliosis?
Osteotomy may be a treatment option for scoliosis in certain cases. It involves cutting and repositioning the vertebrae to improve the spinal alignment and correct the curvature. However, the suitability of osteotomy for scoliosis depends on the severity of the curvature, the patient's age, and other factors that are best evaluated by a spine specialist or orthopaedic surgeon experienced in scoliosis management.
Can osteotomy help in correcting a misaligned jaw?
Yes, osteotomy can be used to correct a misaligned jaw, a condition known as dentofacial deformity. By carefully repositioning the jaw bones, osteotomy can improve the bite, facial symmetry, and overall function. This procedure is commonly performed in collaboration with oral and maxillofacial surgeons.
What is the role of osteotomy in treating congenital bone abnormalities?
Osteotomy plays a crucial role in treating congenital bone abnormalities by correcting deformities and improving functionality. It allows surgeons to reshape and realign the affected bones, ensuring proper growth and development while minimizing future complications.
Can osteotomy be used to correct malunited fractures?
Yes, osteotomy can be used to correct malunited fractures, which refer to fractures that have healed in an abnormal position. By carefully cutting and repositioning the bone, osteotomy can restore proper alignment, improve joint function, and alleviate associated symptoms.
Is osteotomy a common procedure for treating knee pain?
Osteotomy is a common procedure for treating knee pain, especially in cases where the pain is caused by malalignment or early-stage osteoarthritis. By realigning the bones, osteotomy can reduce stress on the affected joint compartment, alleviate pain, and even delay the need for knee replacement surgery.
Can osteotomy help in relieving back pain?
Osteotomy is not typically used as a primary treatment for back pain. However, in certain cases of spinal deformities or abnormalities that contribute to back pain, osteotomy may be considered as part of a comprehensive treatment plan. The suitability of osteotomy for back pain depends on individual factors and requires evaluation by a spine specialist.
What is the success rate of osteotomy procedures?
The success rate of osteotomy procedures varies depending on the condition being treated, the surgical technique used, and individual patient factors. In general, osteotomy has a high success rate in terms of correcting bone deformities, improving function, and reducing pain. However, outcomes can vary, and it is important to discuss expectations with a qualified healthcare provider.
How long do the results of an osteotomy last?
The results of an osteotomy can be long-lasting, particularly when performed for appropriate indications and in conjunction with appropriate postoperative care and rehabilitation. However, the longevity of the results may be influenced by factors like underlying conditions, patient compliance, and the natural progression of certain conditions, such as arthritis.
Can osteotomy be combined with other surgical procedures?
Yes, osteotomy can be combined with other surgical procedures when necessary to achieve the desired outcome. For example, in joint replacement surgeries, osteotomy may be performed as a preparatory procedure to optimize joint alignment and stability before the placement of the artificial joint components.
What type of anesthesia is used during an osteotomy?
The type of anesthesia used during an osteotomy depends on the specific procedure, the patient's overall health, and the surgeon's preference. Osteotomy is performed under general anesthesia, where the patient is unconscious, or under regional anesthesia, such as spinal or epidural anesthesia, where the patient is numbed from the waist down. The anesthesia choice will be discussed and determined by the anesthesia team and surgeon.
Are there any age restrictions for undergoing osteotomy?
There are generally no strict age restrictions for undergoing osteotomy. The suitability of the procedure depends on factors like the patient's overall health, bone quality, and the specific condition being treated. Osteotomy can be performed on both children and adults, with the treatment approach tailored to the individual's needs.
Can osteotomy be performed on children?
Yes, osteotomy can be performed on children, particularly in cases where there are bone deformities or growth abnormalities that can benefit from early intervention. The timing and appropriateness of osteotomy in children will be assessed by a pediatric orthopedic specialist based on factors such as the child's age, growth potential, and the specific condition being addressed.
How is the bone stabilized after an osteotomy?
After an osteotomy, the bone is typically stabilized using various techniques, such as plates, screws, wires, or external fixation devices. These devices provide stability to the bone during the healing process and allow for proper alignment and consolidation of the bone segments.
What is the difference between open and closed osteotomy?
In open osteotomy, a surgical incision is made to directly access the bone and perform the necessary bone cutting and repositioning. In closed osteotomy, the procedure is performed through small incisions or using minimally invasive techniques, often guided by imaging technology. The choice between open and closed osteotomy depends on the specific condition, the surgeon's expertise, and individual patient factors.
Can osteotomy help in correcting bone deformities in the foot?
Yes, osteotomy can be used to correct bone deformities in the foot, such as bunions or flat feet. By carefully repositioning the affected bones, osteotomy can restore proper foot alignment, improve function, and alleviate associated symptoms.
What is the recovery process like after an osteotomy?
The recovery process after an osteotomy varies depending on the specific procedure, the site of the surgery, and individual factors. Generally, it involves a period of immobilization, followed by gradual rehabilitation and physical therapy to restore strength, range of motion, and function. The healthcare team will provide specific instructions and guidelines for postoperative care and rehabilitation.
Can osteotomy help in improving joint function and mobility?
Yes, osteotomy can help improve joint function and mobility by correcting bone deformities and realigning the affected joints. By restoring proper joint mechanics and reducing abnormal forces, osteotomy can enhance joint stability, increase the range of motion, and improve overall joint function.
Are there any non-surgical alternatives to osteotomy?
In some cases, non-surgical alternatives, such as physical therapy, bracing, or orthotic devices, may be considered as initial treatment options for certain conditions. However, the effectiveness of non-surgical alternatives depends on the specific condition, its severity, and individual factors.
Can osteotomy help in correcting facial asymmetry?
Osteotomy can be used to correct facial asymmetry caused by underlying bone deformities. By strategically cutting and repositioning the facial bones, osteotomy can achieve a more symmetrical facial appearance and improve overall facial harmony.
Is osteotomy a common procedure for treating bone tumors?
Osteotomy is not typically used as a primary treatment for bone tumors. The management of bone tumors usually involves a multidisciplinary approach, which may include surgery, radiation therapy, chemotherapy, or a combination of these treatments. The specific treatment plan will depend on the type, location, and extent of the tumor, and will be determined by an oncology specialist.
Can osteotomy be used to treat avascular necrosis?
Osteotomy can be considered as a treatment option for avascular necrosis in some cases. By repositioning the affected bone segment, osteotomy aims to offload the damaged area, promote blood flow to the affected bone, and potentially delay or prevent the progression of avascular necrosis.
What preoperative preparations are necessary for an osteotomy?
Preoperative preparations for an osteotomy typically involve a comprehensive evaluation by the healthcare team. This may include medical history assessment, physical examination, imaging studies, and laboratory tests. The healthcare provider will also provide instructions regarding fasting, medication adjustments, and other necessary preparations.
Can osteotomy help in relieving chronic pain?
Osteotomy can be effective in relieving chronic pain associated with certain bone deformities, joint misalignments, or early-stage arthritis. Addressing the underlying causes of the pain and restoring proper bone alignment helps reduce pain and improve overall quality of life.
Can osteotomy be performed as a revision procedure?
Yes, an osteotomy can be performed as a revision procedure in cases where previous surgery has not achieved the desired outcome, or complications have arisen. Revision osteotomy aims to correct residual deformities, improve function, and address any issues that may have occurred following a previous surgery.
Is osteotomy covered by insurance?
The coverage of osteotomy by insurance varies depending on factors like the specific procedure, the underlying condition being treated, and the patient's insurance plan. Contact the insurance provider and consult with the healthcare team to understand the coverage and potential financial implications.
What is the role of physical therapy in the recovery process after an osteotomy?
Physical therapy plays an integral role during recovery after an osteotomy. It helps promote healing, restore range of motion, improve strength and function, and optimize overall recovery. A tailored physical therapy program is often prescribed to address specific goals and individual needs.
Can osteotomy correct joint instability?
Yes, osteotomy can be used to correct joint instability by realigning the bones and improving the stability and congruence of the affected joint. By addressing the underlying structural abnormalities, osteotomy aims to restore proper joint mechanics and reduce the risk of recurrent instability.
Are there any restrictions or limitations after an osteotomy?
After an osteotomy, there may be certain restrictions or limitations on activities, such as weight-bearing, bending, or lifting. These restrictions are put in place to protect the healing bone and promote optimal recovery. The healthcare team will provide instructions regarding postoperative restrictions and guidelines for a safe and successful recovery.
What are some risks and complications associated with osteotomy?
Like any surgical procedure, osteotomy carries certain risks and potential complications. These can include infection, bleeding, nerve or blood vessel injury, bone nonunion or malunion, limited range of motion, persistent pain, and rare complications specific to the site of surgery. The healthcare team will discuss the specific risks and complications associated with the planned procedure and provide information on how they can be minimized or managed.