Osteotomy

Osteotomy is a surgical method in orthopedic surgery. It involves cutting and reshaping bones. This is done to correct limb alignment, reduce pain, and improve joint function.

This technique is used to treat conditions like arthritis and limb deformities. It changes the bone’s shape and realigns the limb.

The main goal of osteotomy is to spread out the weight-bearing forces across the joint. This helps to alleviate pain and prevent further damage to the joint.

Orthopedic surgeons carefully plan and execute the bone cutting process. They aim to realign the limb, restore proper joint mechanics, and improve mobility and quality of life.

Osteotomy is used for various orthopedic conditions. These include knee malalignment, hip disorders, and congenital or acquired limb deformities. The procedure is customized for each patient, considering the condition’s severity, age, and health status.

What is Osteotomy?

Osteotomy is a surgery that cuts and reshapes bones. It fixes deformities, aligns limbs, and improves joint function. It’s used in orthopedic surgery for many bone and joint issues, like osteoarthritis and misalignments after injuries.

Surgeons plan and make precise cuts to align bones right. This helps redistribute weight, reduces pain, and improves function.

Definition and Purpose of Osteotomy

The term “osteotomy” comes from Greek words for “bone” and “cut”. Its main goal is to fix bone alignment by cutting and moving bones. This reshaping improves joint mechanics, function, and reduces pain.

Osteotomy is used to:

• Realign weight-bearing axes in the lower extremities
• Correct angular deformities
• Redistribute stress on joint surfaces
• Delay or prevent the progression of osteoarthritis

Types of Osteotomy Procedures

Osteotomy procedures vary based on bone cuts and fixation methods. Here are some common types:

The choice of osteotomy technique depends on the deformity’s location and severity, the patient’s age and activity level, and the surgeon’s experience. New techniques and fixation methods have made osteotomy more successful and applied in recent years.

Indications for Osteotomy

Osteotomy is a surgery for many orthopedic issues. It fixes limb deformities, joint misalignments, and early osteoarthritis. It realigns bones and spreads out joint forces. This helps reduce pain, improve movement, and slow down joint damage.

Limb Deformities and Misalignments

Limb deformities and misalignments can come from birth, growth issues, or injuries. They cause uneven weight distribution and stress on joints, leading to pain and wear. Osteotomy corrects these issues, balancing forces and preventing further damage. It’s used for:

• Genu varum (bow legs) or genu valgum (knock knees)
• Tibial or femoral torsional deformities
• Malunited fractures causing angular or rotational deformities

Joint Preservation and Osteoarthritis Management

In early osteoarthritis, osteotomy can be a good choice instead of joint replacement. It shifts the load off damaged areas, easing pain and improving function. It may slow down osteoarthritis. It’s used for:

• Unicompartmental knee osteoarthritis with varus or valgus malalignment
• Hip dysplasia or femoroacetabular impingement (FAI) with early osteoarthritis
• Post-traumatic osteoarthritis with joint incongruity or malalignment

Choosing osteotomy for joint preservation depends on several things. These include the patient’s age, activity level, joint damage extent, and limb alignment. A detailed check-up, including X-rays and gait analysis, helps decide if osteotomy is right for each person.

Preoperative Planning and Imaging

Preoperative planning is key to the success of osteotomy procedures. Imaging like radiographs, CT scans, and 3D models is vital. They help assess bone deformities and plan surgical cuts.

Radiographs are the first tool to check limb alignment and find deformities. They show a two-dimensional view of bones. But for complex cases, CT scans and 3D models are needed.

CT scans give a detailed, three-dimensional view of bones. This helps surgeons plan the exact location and angle of cuts. Here’s a comparison of radiographs and CT scans in planning:

Recently, 3D models have become more popular in planning osteotomy procedures. These models, made from CT scan data, show the patient’s anatomy clearly. Surgeons can test different cuts and fixation methods on these models. 3D models are very helpful for complex cases or when custom tools are used.

Using advanced imaging and detailed planning, surgeons can reduce risks and get better results for patients. This is true for osteotomy procedures.

Surgical Techniques in Osteotomy

Osteotomy procedures use different surgical techniques for each deformity. The choice depends on the deformity’s location, severity, and type. It also depends on the surgeon’s expertise and preference. Let’s look at three common techniques: closing wedge osteotomy, opening wedge osteotomy, and dome osteotomy.

Closing Wedge Osteotomy

Closing wedge osteotomy removes a bone wedge to fix angular deformities. It’s great for correcting varus or valgus deformities in the lower legs. The surgeon makes two cuts, removes the wedge, and aligns the bone surfaces.

This technique often needs plates and screws for stability during healing.

Opening Wedge Osteotomy

Opening wedge osteotomy corrects angular deformities, mainly in the lower legs. It makes a single cut and opens the wedge for correction. The gap is filled with bone graft to help healing and keep the correction.

This method is used for conditions like bowlegs and knock-knees.

Dome Osteotomy

Dome osteotomy, or barrel-vault osteotomy, corrects rotational deformities or realigns joints. It makes a curved cut in the bone, then rotates it for correction. This technique is used in the hip and wrist to fix deformities.

The right technique for osteotomy depends on the deformity, patient, and surgeon. Each method has its benefits and challenges. The goal is to align the bone well, restore function, and improve outcomes. New tools and imaging help make these techniques better.

Fixation Methods and Implants

After an osteotomy, the bone needs to be held in place for healing. Orthopedic surgeons use fixation methods and implants to do this. They choose the best method based on the patient’s needs.

Internal Fixation with Plates and Screws

Internal fixation is a common way to stabilize bones after an osteotomy. It uses plates and screws to keep the bone in the right spot. The plates are made of titanium or stainless steel and fit the bone’s surface.

This method allows patients to move around and bear weight sooner. This helps them recover faster.

The choice of plates and screws depends on the osteotomy’s location and complexity. For example:

External Fixation Techniques

In some cases, external fixation is better than internal fixation. This method uses pins or wires in the bone and connects them to an external frame. It’s good for areas with poor bone quality or soft tissue healing issues.

External fixation has benefits like adjusting alignment after surgery and lower infection risk. But, it can be hard for patients to move around. They also need to take care of the pins to avoid problems.

Postoperative Care and Rehabilitation

After osteotomy surgery, postoperative care and rehabilitation are key for a good recovery. It’s important to take care of the wound by changing dressings and watching for infection signs.

Pain management is also critical. Doctors may give pain and inflammation medicines. This helps patients do physical therapy more easily. Physical therapy is vital for getting strength, flexibility, and movement back in the affected limb.

In the first weeks, weight-bearing is limited to help the osteotomy heal. Patients might use crutches, walkers, or canes. As healing advances, they can start to bear more weight, guided by the surgeon and physical therapist.

Physical therapy exercises aim to boost muscle strength, joint mobility, and function. Each patient’s rehabilitation plan is customized based on their osteotomy and needs. They learn how to do daily tasks safely during recovery.

As rehabilitation moves forward, exercises get more challenging. Patients work on balance, proprioception, and specific functional exercises. They also start to return to sports or work. Regular check-ups with the surgeon and physical therapist are important to track progress and make any needed changes.

The time it takes to fully recover varies. It depends on the osteotomy type, location, and the patient’s health. It can take months to get back to full activities. Following the postoperative care and rehabilitation plan closely, and staying in touch with the healthcare team, is key for the best results after osteotomy surgery.

Complications and Risk Management

Osteotomy procedures aim to fix limb deformities and improve joint function. But, they also come with risks and complications. To manage these risks, careful planning, precise surgery, and close postoperative care are key. This ensures the best outcomes for patients.

Infection Prevention and Treatment

Infection is a serious risk that can affect the success of an osteotomy. Using strict sterile techniques and giving antibiotics before surgery can prevent infections. If an infection happens, quick diagnosis and treatment with antibiotics are vital. This helps prevent more problems and aids in healing.

Nonunion and Malunion

Nonunion and malunion are complications where the bone doesn’t heal right. These issues can arise from several factors:

Regular checks with X-rays and clinical exams can spot nonunion and malunion early. This allows for quick action to fix the problem.

Neurovascular Complications

Osteotomy procedures can risk nerves and blood vessels. It’s important to plan and execute surgery carefully to avoid these risks. Intraoperative monitoring techniques, such as nerve stimulation and Doppler ultrasound, help protect important structures. If a nerve or blood vessel is injured, quick action is needed to prevent lasting damage.

Osteotomy in Specific Anatomical Regions

Osteotomy procedures are designed to fix specific problems in different body parts. Surgeons tailor each procedure to meet the unique needs of each area. This approach helps improve patient outcomes and quality of life. Let’s look at how osteotomy is used in the knee, hip, and wrist.

High Tibial Osteotomy for Knee Malalignment

High tibial osteotomy is a surgery for knee problems. It’s mainly for those with osteoarthritis in one part of the knee. The surgery realigns the knee to reduce pain and improve function. It might also delay the need for a full knee replacement.

Femoral Osteotomy for Hip Disorders

Femoral osteotomy treats hip issues like developmental dysplasia and Legg-Calve-Perthes disease. It reshapes the femoral head or neck to improve joint alignment and stability. This reduces pain and enhances hip function.

Proximal femoral osteotomy corrects abnormal angles or torsion. Intertrochanteric osteotomy addresses more complex deformities.

Distal Radius Osteotomy for Wrist Deformities

Distal radius osteotomy fixes wrist problems like malunited fractures or congenital issues. It realigns the distal radius to restore wrist anatomy and improve movement. The type of correction needed depends on the deformity.

Accurate preoperative planning and precise execution are key for the best results. This ensures the wrist functions well after surgery.

Advancements in Osteotomy Techniques

Osteotomy techniques have seen big changes in recent years. These changes include computer-assisted navigation and patient-specific instrumentation. These new tools are making osteotomy procedures more precise and accurate.

Computer-Assisted Navigation

Computer-assisted navigation systems are changing osteotomy procedures. They use advanced software and real-time images. This lets surgeons plan and do osteotomies with great precision.

These systems give a detailed 3D view of the patient’s body. This helps surgeons plan better before surgery and guide during it. It ensures the best results for patients.

Patient-Specific Instrumentation

Patient-specific instrumentation is a big step in personalized medicine for osteotomy. It uses advanced imaging and 3D printing to make custom tools and implants. These are made to fit each patient’s body perfectly.

These tools are made from scans or MRI images. They make the surgery more accurate and reduce risks. This also makes the surgery more efficient.

The new tools in osteotomy are making a big difference. They let surgeons do osteotomies with great precision and tailor each surgery to the patient. As research keeps going, these advancements will keep improving osteotomy techniques. This will help more patients with orthopedic problems.