Let's learn about bone surgery. What is an osteotomy?

Have you ever heard of surgery that involves cutting, reshaping, or re-aligning bones? You may think this is a bit complicated and scary. However, with the advancement of medical science , many people have found relief from such surgeries. Today we are going to talk about one such special surgery, which is called an osteotomy .

What is Osteotomy?

Simply put, an osteotomy is a surgical procedure that involves cutting a bone (sometimes adding bone tissue) to change the shape or position of your bones. Think of it like a carpenter cutting, shaping, and fitting a piece of wood.

Your surgeon can perform an osteotomy on any bone in your body. For example, it can be done on your jaw, elbow, spine, shoulder, hip, knee, leg, toe, and foot. It is especially used to treat joint problems. A joint is where two or more bones meet.

There are many different types and techniques of osteotomy . Sometimes these techniques are named after the surgeon who invented the technique, or according to the way the bone is cut or reshaped.

Why is an Osteotomy performed?

Now you might be wondering, why are we going to cut this bone and fix it? There are several reasons for performing an osteotomy. Let's take a look at what they are:

• Correct the angle, bend, or rotation of your bones. Sometimes bones may be stretched or misaligned.
• Correct the position of a joint that is deformed or not properly joined.
• Shorten or lengthen the bone.
• Repair a damaged joint.
• Your body weight, normal or healthy cartilage, can be damaged by a joint injury. Cartilage ()` is moved to a place where there is less pressure on the damaged area.
• Reduce pain caused by osteoarthritis, especially in the knees and hips.
• Postpone the need for joint replacement surgery in young, active people.
• Repair or correct other specific bone problems .

How to prepare for an Osteotomy surgery?

Before undergoing this type of surgery, your surgeon will order several tests to check your general health. These include:

• Blood tests: These check the levels of certain components in your blood and how well your organs are working.
• Urine tests : These can help check your general health and identify conditions such as infection or diabetes mellitus that may be interfering with bone healing.
• Electrocardiogram (ECG) test: This checks the electrical activity of your heart.
• Chest X-ray: To make sure your lungs are working properly before surgery.
• X-rays or CT scans: These are used to plan the surgery by looking at your bones/joints. This is essential for the surgeon to determine the exact size, shape, and angle of the bone to be removed. Sometimes a computer is used to create a 3D model of the surgery.

Important: With all of these tests, doctors are trying to determine whether you can have surgery and how successful it will be. Therefore, it is very important to get these tests done correctly.

How is an osteotomy usually performed?

Okay, now let's see how this surgery is usually done.

First, you will be given anesthesia . The surgeon may decide to use one of these methods:

• Regional anesthesia, which numbs only the area where the surgery is performed.
• Spinal anesthesia numbs your body from the waist down.
• You will be put completely to sleep (general anesthesia).
• Local anesthesia, which numbs only the area where the surgery is performed.

Next, the surgical team cleans the area around the operation site with an antibacterial solution. Then, the area is covered with a surgical cloth.

The surgeon makes an incision through your skin. Then, using guide wires, they mark the area of ​​bone to be removed (usually wedge-shaped, but this can vary depending on the surgery). A special surgical saw is used to remove this marked area of ​​bone.

After removing the diseased or damaged bone, the bone is brought together to close the gap. Depending on your specific osteotomy, a bone graft may be placed in the area of ​​the removed bone. Then, pins, screws, staples, plates, or rods are used to hold the bone in place or to realign it until it heals. These metal parts can be placed temporarily or permanently.

What are the main types of osteotomy?

Osteotomy surgery can treat many different types of bone and joint problems. Let's take a look at some of the main types.

Jaw Osteotomy

A jaw osteotomy is a procedure that realigns the bones of your lower jaw (mandible) or upper jaw (maxilla) with the rest of your skull and/or teeth. This can correct problems such as an open bite, difficulty chewing or swallowing, excessive wear of teeth, a receding chin, overbite, or underbite. You may also need braces before or after surgery to help align your teeth with your jaw.

Several jaw-related osteotomy techniques:

• Mandibular osteotomy: This is a surgery performed on the lower jaw.
• Maxillary osteotomy: This is a surgery performed on the upper jaw.
• LeFort osteotomy: This is a special surgical procedure that is used to repair a fracture in the middle of your face, which is where the bone meets the upper jaw.
• Sagittal split osteotomy: This is a type of jaw surgery that moves the lower jaw to better align it with the teeth.

Chin Osteotomy

A chin osteotomy changes the shape of your chin. It is usually done to create a vertically short chin, lengthen the chin, or shorten a narrow chin. This surgery moves your chin forward or in a different direction. It is sometimes done as an alternative to a chin implant.

This involves cutting and moving your jawbone. The surgeon makes the incision from inside your mouth. You may lose feeling in your lips for a few months after the surgery.

Elbow Osteotomy

An elbow osteotomy corrects problems in the elbow joint that are causing problems with the position of your forearm. This can cause your arm to be either too close to your body (cubitus varus) or too far away from your body (cubitus valgus). These abnormal positions change the carrying angle of your elbow. There are different osteotomy techniques depending on the specific problem.

Spinal Osteotomy

A spinal osteotomy corrects the curvature of your spine. The natural curvature of your spine causes your body's center of gravity to be directly over your pelvis. The pelvis is the bony structure at the bottom of your torso. If one or more parts of your spine curve too much or too little, your spine is out of alignment. This can cause pain, stiffness, and pressure on your internal organs. The goal of this surgery is to restore balance, reduce pain, and prevent the deformity from recurring or getting worse.

For example, your surgeon may consider an osteotomy to correct an angle problem where your chin is permanently bent forward to the point where it hits your chest. This can happen in a condition called ankylosing spondylitis. This is a type of arthritis. In severe cases, it can cause parts of the spine to fuse together.

The main types of spinal osteotomies are:

• Posterior column osteotomy: This surgery corrects the inward curve (lordosis) in your lower back and the forward curve (kyphosis) in your upper back. Ponte osteotomy is a special procedure used to correct kyphosis.
• Smith-Petersen osteotomy: This special procedure creates lordosis. A piece of bone is removed from the back of the spine, tilting the spine backward.
• Pedicle subtraction osteotomy: This surgery corrects more severe lordosis (a large curve) in the lower back.
• Bone-disk-bone osteotomy: This surgery creates a spinal canal above and below a disc between the vertebrae. The disc and its adjacent endplates are removed during the surgery.
• Vertebral column resection: In this surgery, one or more vertebrae are completely removed. This is the most significant correction. Because a large amount of bone is removed, the surgeon fuses the area of ​​the spine with a graft or metal cage.

Hip Osteotomy

A hip osteotomy reshapes your hip socket (acetabulum) and/or the head of your thigh bone (femur head). This is your ball-and-socket hip joint. The surgeon cuts, shapes, or removes part of the bone to realign the weight-bearing surfaces of the joint.

Main types of hip osteotomy:

• Periacetabular osteotomy: This is done to correct hip dysplasia (a condition where your hip socket does not completely cover the ball of your thigh bone). During the surgery, a section of your hip bone is cut, repositioned, and secured with screws.
• Femoral osteotomy: This surgery cuts and reshapes your upper thigh bone (femur) to help restore hip function.

Knee Osteotomy

In a knee osteotomy, one of the two bones that join together under your kneecap – either your shin bone (tibia) or your thigh bone (femur) – is cut and reshaped. This is usually done to repair damage caused by arthritis. The surgery realigns your knee joint, shifting weight and pressure from the damaged side of the knee to the healthy side. A knee osteotomy is usually done in the early stages of osteoarthritis, when the damage is only on one side of the knee joint.

Think of it like changing the way your weight is distributed, reducing the weight on the damaged side of your knee and putting more weight on the good side. This not only reduces pain, but also controls further damage to the joint.

The location of the knee osteotomy depends on the location of the damage. For example, in a high tibial osteotomy, the cartilage damage is on the inside of the knee. The surgery either removes a wedge of bone from the outside of the knee or opens up a wedge of bone on the inside of the knee. This straightens the leg and prevents further progression of arthritis.

Several types of knee osteotomies:

• Tibial osteotomy: This surgery creates a bowlegged alignment that puts excessive pressure on the inside of the knee.
• High tibial osteotomy: This surgery realigns the knee joint in people with knee arthritis. It can prevent or delay the need for partial or total knee replacement.
• Fulkerson osteotomy: This is a special procedure. In this, part of the tibial tubercle, a special area on your tibia, is removed. This changes the place where your kneecap tendon attaches to the tibia, reducing pressure on the kneecap and preventing it from dislocating.

Big toe and foot osteotomies

A hallux osteotomy removes bone from the big toe to straighten it. A calcaneus osteotomy is a surgery to reshape the foot to correct flat feet or a higher-than-normal arch.

Several special osteotomy techniques that treat foot problems:

• Chevron and Akin osteotomies: These procedures correct mild to moderate bunion problems (hallux valgus).
• Dwyer osteotomy: This procedure changes the shape of the foot to reduce an abnormally high arch.
• Weil osteotomy: This procedure corrects claw toes and pain under the ball of your foot.
• Cotton osteotomy: This procedure helps to create an arch in the foot.

What are the risks of an osteotomy?

Like any surgery, an osteotomy can carry some risks. But don't worry, your medical team will do their best to minimize these risks. The main risks are:

• Problems related to anesthesia.
• Infection.
• Blood clots.
• Damage to nerves or arteries.
• When bones heal, they do not heal properly or are not aligned properly.
• Joint inflammation and stiffness.
• Long-term pain.
• Scar tissue formation.

What to expect during recovery?

The recovery time depends on the type of osteotomy you had, the specific surgical technique, the extent and severity of your bone damage, and your strength and stamina.

It takes time for a bone to heal. You will feel pain where the surgery was performed.

You may need to wear a cast, splint, or crutches . These will help limit the movement of the bone and joint, reduce the amount of weight that is put on the bone that was operated on, and allow the bone to heal in the correct position. These will usually last from a few weeks to about two months.

Even if you are in a cast or splint, physical therapy will begin within a few days of surgery. Physical therapy will help increase the strength and range of motion in your joint.

If your surgery was on your knee or hip, you will need to use crutches for several months. You will also need physical therapy to regain your strength and balance.

If you have a jaw osteotomy, your jaw will be wired shut, and you will be on a liquid diet for about six weeks. If you have a big toe osteotomy, you will not be able to wear shoes or drive for two to six weeks.

How can you help the healing process?

You too can help speed up the healing process. How?

• Avoid smoking. Nicotine slows down the healing process and can prevent your bones from healing properly.
• Eat a healthy, mostly plant-based diet (e.g., the Mediterranean diet).
• Follow your healthcare provider's instructions.
• Maintain a healthy weight.

What outcomes can be expected? (Outcomes)

The results you get will depend on your general health, the severity of your bone problem, the specific surgery you had, and the expertise of your surgeon. Your surgeon will talk to you about your specific surgery and what to expect. Don't hesitate to ask your surgeon any questions or concerns you may have.

Osteotomy procedures, and their variations, realign and reshape your bones and joints. Your surgeon will discuss your specific bone or joint problem and the options available with you. Depending on your specific bone problem, you may first start with conservative treatments. These may include rest, ice, anti-inflammatory and pain medications, and corticosteroid injections. If these treatments do not control your joint problems or are not considered, remember that your orthopedic surgeon is there to help you. They may also have surgical options to improve your mobility and reduce your pain and discomfort.

Finally, the most important things to remember (Take-Home Message)

The word ``Osteotomy'' may sound a little scary, but it is actually a successful surgery that has brought relief to many people's lives, improved their mobility, and reduced pain.

Remember, if you have been recommended this type of surgery, there is a reason for it. Talk to your doctor, ask all your questions, and prepare for the surgery. With proper preparation and proper post-operative care, you can achieve the best results. You are not alone, and you have a team of doctors to help you.

We hope this information is useful to you. Stay healthy!

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