Let's learn everything about bone surgery (Osteotomy) in a simple way!

Do you sometimes wonder if the pain you feel in certain parts of your body, especially your knees, hips, or spine, is due to a small bone misalignment or a fracture? Your doctor may have told you about a surgery called an osteotomy. It can be a bit scary to hear about this. But when you know the details, that fear is greatly reduced. So, today, shall we talk about this surgery simply?

Simply put, what is this (Osteotomy)?

Okay, to put it simply, an osteotomy is a surgical procedure. It involves cutting a bone, sometimes adding new bone, and then reshaping the bone or moving it back into its proper position. Think of it like a carpenter cutting a piece of wood, reshaping it, and giving it a new shape, but this is done on the bones in our body.

Your surgeon can perform an osteotomy on any bone in your body. For example, in your jaw, elbow, spine, shoulder, hip, knee, leg, toe, or foot. It is often used to treat problems in your joints – where two bones meet. There are many different types of osteotomy and techniques. They are often named after the surgeon who invented the procedure or the way the bone is cut and reshaped.

Why is this (Osteotomy) surgery performed?

Now you might be wondering, 'Why do you have to cut the bones like this?' There are several reasons.

• Correct the angle, bowing, or rotation of the bones: Sometimes the bones can be a little out of place. This surgery helps to correct that. Think about it, some people's legs may be shaped like the letter O (bowlegs) or like the letter X (knock-knees). This is used to fix things like that.
• Correct a deformed or misaligned joint: Some joints can be born with minor defects, or they can become deformed due to some problem later in life.
• Shorten or lengthen bones: Isn't it amazing? Yes, in some cases this method is also used to change the length of bones.
• Repair a damaged joint: If a joint has been damaged due to an accident or other reason.
• Change the weight-bearing area of ​​a joint: Imagine that the cartilage on one side of your knee has worn away. That's when you feel pain. This surgery can change the way the weight is carried and redirect it to the side with healthy cartilage. That will reduce the pain.
• Reduce pain caused by osteoarthritis: This is a good solution to reduce pain caused by this degenerative joint disease, especially in the knees and hips.
• Postpone joint replacement surgery for young, active people: For some young people, osteotomy allows them to use their joint for a longer period of time rather than having a joint replaced right away when the joint wears out.
• Correct other specific bone problems.

What should I do before surgery?

Before you have an osteotomy, your surgeon will order several tests to check your general health. These usually include:

• Blood tests: These check the levels of various components in your blood and how your internal organs are working.
• Urine tests: These can help determine your general health and detect any conditions that may be interfering with bone healing, such as infection or diabetes.
• ECG (Electrocardiogram) test: 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 clearly. The surgeon needs to know exactly the size, length, width, and angle of the bone to be removed. Sometimes a 3D model is created using a computer to plan the surgery.

What usually happens during an Osteotomy surgery?

First, you will be given anesthesia. This can be done in different ways:

• Regional anesthesia is the numbing of only the area where the surgery will be performed.
• Spinal anesthesia.
• Putting you completely to sleep (general anesthesia).
• Local anesthesia is used to numb only the area where the surgery will be performed.

The doctor will choose the method that is most suitable for you.

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

The surgeon makes an incision in your skin. They use guide wires to mark the area of ​​bone to be removed (often in the shape of a wedge, but this varies 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 gap is closed by joining the remaining parts of the bone on either side. Depending on the type of osteotomy you have, a bone graft may be placed in the area where the bone was removed. Then, pins, screws, staples, plates, or rods are used to hold the bone in place until it heals. Some of these metal pieces are temporary, while others are permanent.

What are the main types of osteotomy surgeries?

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

Jaw osteotomy

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

• Surgery performed on the lower jaw is called a mandibular osteotomy .
• Surgery performed on the upper jaw is also called a maxillary osteotomy .
• There are some specific procedures, for example, a LeFort osteotomy is a surgery to repair a fracture in the middle of the face where the upper jaw meets the jawbone. A sagittal split osteotomy is a type of jaw surgery to move the lower jaw to better align with the teeth.

Chin osteotomy

This surgery is done to change the shape of the chin. It is usually done to lengthen the chin if it is too low, or to make a narrow chin shorter. This can move the chin forward or in a different direction. Sometimes this is a better option than having a chin implant. During this surgery, your jawbone is cut and moved. The surgeon makes an incision inside the mouth. You may lose feeling in your lips for a few months.

Elbow osteotomy

If problems with the elbow joint are causing problems with the position of your lower arm, such as if the arm hangs too close to the body (cubitus varus) or too far away from the body (cubitus valgus), this surgery is performed to correct such problems. There are different types of osteotomy depending on the problem.

Spinal osteotomy

This surgery is done to correct the curves of the spine. The natural curves of our spine help keep the body's center of gravity over the pelvis. If the curve in one or more parts of the spine increases or decreases, the spine is not straight. This can cause pain, fatigue, and pressure on internal organs. The goal of this surgery is to restore balance to the spine, reduce pain, and prevent the disorder from recurring or worsening.

• For example, in a condition like Ankylosing Spondylitis , the spine can become permanently bent forward and the chin can touch the chest. This surgery can be considered to correct such angular problems.
• There are several main types:
• Posterior column osteotomy: This creates a lordosis in the lower back and a kyphosis in the upper back. Ponte osteotomy is a special technique used to correct kyphosis.
• Smith-Petersen osteotomy: This is a special procedure used to correct lordosis. A piece of bone is removed from the back of the spine to tilt the spine backward.
• Pedicle subtraction osteotomy: This creates a strong inward curve (lordosis) in the lower back.
• (Bone-disk-bone osteotomy): This involves creating a bone above and below the disc between the vertebrae. During the surgery, the disc and its adjacent endplates are removed.
• (Vertebral column resection): In this, one or more vertebrae are completely removed. This can make the most significant correction. Because a large amount of bone is removed, the surgeon fills this area with a bone graft or a metal cage.

Hip osteotomy

This involves reshaping your acetabulum or femur head. This is the ball-and-socket hip joint in your hip. The surgeon cuts, shapes, or partially removes the bone to realign the weight-bearing surfaces of the joint.

• Main types:
• Periacetabular osteotomy: This is done to correct hip dysplasia, a condition in which the hip socket does not completely cover the ball of the thigh bone. During the surgery, a portion of the hip bone is cut, repositioned, and secured with screws.
• Femoral osteotomy: This involves cutting and reshaping the upper thigh bone (femur) to help restore hip function.

Knee osteotomy

An osteotomy involves cutting and reshaping one of the two bones found under the kneecap – either the tibia or the femur. This is often done to repair damage caused by arthritis. This surgery realigns the 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.

• The location of the osteotomy depends on the location of the damage. For example, in a high tibial osteotomy , if the cartilage damage is on the inside of the knee, a wedge-shaped piece of bone is removed from the outside of the knee, or the bone is opened up in a wedge-shaped way on the inside of the knee. This straightens the leg and prevents the arthritis from getting worse.
• Some types of knee (Osteotomy):
• Tibial osteotomy: This creates a bowlegged alignment that places excessive pressure on the inside of the knee.
• High tibial osteotomy: This is used to realign the knee joint in people with knee arthritis. This surgery can prevent or delay the need for partial or total knee replacement.
• Fulkerson osteotomy: This is a special procedure. A specific area of ​​the tibia (tibial tubercle) is removed. This changes the place where the kneecap tendon attaches to the tibia, reducing pressure on the kneecap and preventing it from dislocating.

Big toe and foot osteotomies

A hallux osteotomy is a procedure that involves removing a bone from the big toe and straightening it. A calcaneus osteotomy is a procedure that reshapes the foot to correct flat feet or feet with a higher arch than normal.

• Several specific (Osteotomy) methods for treating foot problems:
• Chevron and Akin osteotomies: These surgeries correct mild to moderate deformities of the big toe caused by bunions (hallux valgus).
• (Dwyer osteotomy): This reshapes the foot to reduce an abnormally high arch.
• (Weil osteotomy): This corrects claw toes and pain under the ball of your foot.
• (Cotton osteotomy): This helps create an arch in the foot.

What are the risks of this surgery?

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

• Problems with anesthesia.
• Infection.
• Blood clots.
• Nerve or artery injury.
• It's okay for bones to not set properly or to not heal properly when they heal.
• Joint inflammation and stiffness.
• Long-term pain.
• Formation of scar tissue.

It is very important to talk to your doctor about these risks and ask all the questions you have.

How long will it take to heal? What should I do?

Recovery time can vary from person to person. It depends on many things, including the type of osteotomy you had, the surgical technique, the extent and severity of the damage to your bones, your strength, and your willingness to heal.

It takes time for a bone to heal. There will be pain at the site of the surgery, and there will be soreness until the wound heals.

• You may need to wear a cast, splint, or crutches. These will help limit movement of the bones and joints, reduce weight on the operated bone, and allow the bones to heal properly. 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 joints.
• If you had surgery on your knee or hip, you may need to use crutches for a few months. You will need to continue physical therapy to regain your strength and balance.
• If you have had jaw surgery (jaw osteotomy), your jaw will be wired shut and you will be on a liquid diet for about six weeks. If you have had surgery on your big toe, you will not be able to put on shoes or drive for about two to six weeks.

How can you help the healing process?

You too can help during this healing time.

• Don't smoke: Nicotine slows down the healing process and can also interfere with proper bone healing. So, avoid smoking completely .
• Eat a good, healthy diet: Eat a balanced diet, such as the Mediterranean diet, with plenty of vegetables and fruits.
• Follow your doctor's instructions exactly.
• Maintain a healthy weight.

What results can be expected?

The results you get will depend on factors such as your general health, the severity of your bone problem, the specific surgery you had, and the skill of your surgeon. Your doctor will talk to you about the surgery you are going to have and what to expect after the surgery. Never hesitate to ask your doctor questions or share any concerns or fears you have.

There are many different types of osteotomy and other surgical procedures to realign and reshape bones and joints. Your doctor will talk to you about your specific bone or joint problem and the options available. Depending on the nature of your bone problem, you may first be treated with nonsurgical treatments (conservative treatments). These may include rest, ice, anti-inflammatory and pain medications, and corticosteroid injections. If these treatments don't control your joint problems, or if you have a condition that can't be treated, remember that your orthopedic surgeon is there to help you. They have surgical options to improve your mobility and reduce your pain and discomfort.

The most important things to remember in this article

So, it's normal to feel a little scared when thinking about an osteotomy. However, this is an important medical procedure that can improve your quality of life, reduce pain, and give your bones and joints new life.

• Be well informed: Talk to your doctor about your condition, the surgery you are going to have, its pros and cons, and the recovery time.
• Follow your doctor's instructions: It is very important for a speedy recovery to follow your doctor's instructions carefully, both before and after surgery.
• Be patient: It takes time for the bones to heal. During that time, do things like physical therapy properly and stay strong.
• Avoid smoking: This is definitely something you should do.

If you have any more questions about this, don't be afraid to ask your doctor. They are there to help you.

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