Osteotomy is a surgical procedure where a bone is cut and realigned or repositioned to improve the forces going through the area.
Page updated May 2024 by Dr Sheila Strover (Clinical Editor)
Strong metal or carbon fibre plates and screws ("hardware") are used fix the bones in the new position, until new bone heals the defect, after which time the surgeon and patient may elect to remove the plate.
When is an osteotomy indicated?
Osteotomies may be performed when a poor alignment of the joint results in limb deformity or pain, or to decrease the forces going through a vulnerable area such as the meniscus in the knee.
Osteotomy may also be done to improve the cosmetic appearance of a limb or joint.
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Quote from peer-reviewed paper:
"........Osteotomy..."is an effective treatment for knee osteoarthritis and has unique advantages compared to knee arthroplasty. Knee arthroplasty is at a high risk of postoperative infection. What's worse, younger patients who have had the replacement may need repeated revisional surgery afterwards...."
Citation: Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, Zhang Y, Zhang Y. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021 Jul;13(5):1465-1473. doi: 10.1111/os.13021. Epub 2021 Jun 10. PMID: 34110088; PMCID: PMC8313165.
Common osteotomy procedures in the knee
Common osteotomy procedures relating to the knee include -
- high tibial osteotomy
- distal femoral osteotomy
- tibial tubercle osteotomy
- derotation osteotomy
Planning software for osteotomy
Planning software with full-length weight-bearing X-rays allows pre-operative calculation of the required amount of wedge correction in the tibia in mm.
Laminar spreaders open the wedge of a high tibial osteotomy, and then the bone is held in the new position with a plate and screws until new bone fills the gap.
Rehabilitation after osteotomy
Rehabilitation after osteotomy requires a balance between keeping the limb moving and the muscles strong, and avoiding damage to the hardware (plates and screws) until the bone reunites.
The patient will be keep non-weight-bearing on crutches for some weeks, and gradually start to bear weight. Hydrotherapy allows exercise in a non-weight-bearing environment.
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Quote from peer-reviewed paper:
"....an aquatic rehabilitation protocol....demonstrated significant improvements in the evaluated parameters of pain and amplitude of the lower limbs...."
Citation: Santos S. Rehabilitation protocol after osteotomy of the tibia and varus femur - Case study. Ann Afr Med. 2021 Jul-Sep;20(3):235-240. doi: 10.4103/aam.aam_29_20. PMID: 34558455; PMCID: PMC8477284.
Forum discussions
- Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 6/13/11
Complex surgery - with loads of support from forum readers.
- Rotational deformities of the leg
A number of useful discussions.
See also:
2018 - 
eBook - Knee arthritis interventions when you are too young for a knee replacement
Written by Dr Sheila Strover (Clinical Editor) and free to download.
List - Who's Who in Osteotomy for knee pain?
A list of knee surgeons with known expertise in osteotomies around the knee.