An osteotomy is a surgical
operation
Operation or Operations may refer to:
Arts, entertainment and media
* ''Operation'' (game), a battery-operated board game that challenges dexterity
* Operation (music), a term used in musical set theory
* ''Operations'' (magazine), Multi-Ma ...
whereby a
bone
A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...
is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a
hallux valgus
A bunion, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complicat ...
, or to straighten a bone that has healed crookedly following a
fracture. It is also used to correct a
coxa vara
Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened and the development of a limp. It may be congenital and is commonly cau ...
,
genu valgum Genu, a Latin word for "knee," may refer to:
* Genu of internal capsule
* Genu of the corpus callosum
* Genu recurvatum
* Genu valgum
* Genu varum
Genu varum (also called bow-leggedness, bandiness, bandy-leg, and tibia vara) is a varus def ...
, and
genu varum
Genu varum (also called bow-leggedness, bandiness, bandy-leg, and tibia vara) is a varus deformity marked by (outward) bowing at the knee, which means that the lower leg is angled inward ( medially) in relation to the thigh's axis, giving th ...
. The operation is done under a
general anaesthetic
General anaesthetics (or anesthetics, see spelling differences) are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma ...
.
Osteotomy is one method to relieve pain of arthritis, especially of the hip and knee. It is being replaced by joint replacement in the older patient.
Due to the serious nature of this procedure, recovery may be extensive. Careful consultation with a physician is important in order to ensure proper planning during a recovery phase. Tools exist to assist recovering patients who may have non–
weight bearing In orthopedics, weight-bearing is the amount of weight a patient puts on an injured body part. Generally, it refers to a leg, ankle or foot that has been fractured or upon which surgery has been performed, but the term can also be used to refer to ...
requirements and include bedpans, dressing sticks, long-handled shoe-horns, grabbers/reachers and specialized walkers and wheelchairs.
Osteotomies of the hip
![FO after](https://upload.wikimedia.org/wikipedia/commons/d/d6/FO_after.jpg)
Two main types of osteotomies are used in the correction of hip dysplasias and deformities to improve alignment/interaction of
acetabulum – (socket) – and femoral head (
femur head
The femoral head (femur head or head of the femur) is the highest part of the thigh bone (femur). It is supported by the femoral neck.
Structure
The head is globular and forms rather more than a hemisphere, is directed upward, medialward, and a ...
) – (ball), innominate osteotomies and femoral osteotomies. The bones are cut, reshaped or partially removed to realign the load-bearing surfaces of the joint.
![X-ray of the hip after (a) open reduction, capsulorrhaphy and Dega and (b) Chiari surgery](https://upload.wikimedia.org/wikipedia/commons/9/91/X-ray_of_the_hip_after_%28a%29_open_reduction%2C_capsulorrhaphy_and_Dega_and_%28b%29_Chiari_surgery.jpg)
Adjustments are made to part of the
hip-bone. Many operating methods and variations have been developed. They are defined by the type of cut and adjustment made. Some acetabular procedures are named after the surgeons who first described them as Salter (R. Salter), Dega (W. Dega), Sutherland (D.H. Sutherland), Chiari (K. Chiari): other names one may encounter are Ludlov, P. Pemberton, and James B. Steele. Some are named after the shape of cut (e.g. Chevron, Wedge) or the way the bones are aligned (Dial=old style rotary dial phone).
A femoral derotation osteotomy can be performed to correct version abnormalities such as excessive anteversion or retroversion of the hip joint. Excessive anteversion of the femur results in anterior instability of the hip joint while excessive retroversion results in femoroacetabular hip impingement.
A subtrochanteric blade plate or an intramedullary rod can be used to stabilize the osteotomy site in a femoral derotation osteotomy until compete bone healing is achieved; an approach employing an intramedullary rod is much less invasive than one using a subtrochanteric blade plate.
Femoral osteotomies, as the name indicates, involves adjustments made to the femur head and/or the
femur
The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...
.
Osteotomy of the knee
![Osteotomy tibia en](https://upload.wikimedia.org/wikipedia/commons/2/2e/Osteotomy_tibia_en.svg)
Knee osteotomy is commonly used to realign arthritic damage on one side of the knee. The goal is to shift the patient's body weight off the damaged area to the other side of the knee, where the cartilage is still healthy. Surgeons remove a wedge of the tibia from underneath the healthy side of the knee, which allows the tibia and femur to bend away from the damaged cartilage.
A model for this is the hinges on a door. When the door is shut, the hinges are flush against the wall. As the door swings open, one side of the door remains pressed against the wall as space opens up on the other side. Removing just a small wedge of bone can "swing" the knee open, pressing the healthy tissue together as space opens up between the femur and tibia on the damaged side so that the arthritic surfaces do not rub against each other.
Osteotomy is also used as an alternative treatment to total knee replacement in younger and active patients. Because prosthetic knees may wear out over time, an osteotomy procedure can enable younger, active osteoarthritis patients to continue using the healthy portion of their knee. The procedure can delay the need for a total knee replacement for up to ten years.
Surgery
The location of the removed wedge of bone depends on where osteoarthritis has damaged the knee cartilage. The most common type of osteotomy performed on arthritic knees is a high tibial osteotomy, which addresses cartilage damage on the inside (medial) portion of the knee. The procedure usually takes 60 to 90 minutes to perform.
During a high tibial osteotomy, surgeons remove a wedge of bone from the outside of the knee, which causes the leg to bend slightly inward. This resembles the realigning of a bowlegged knee to a knock-kneed position. The patient's weight is transferred to the outside (lateral) portion of the knee, where the cartilage is still healthy.
After regional or general anesthesia is administered, the surgical team sterilizes the leg with antibacterial solution.
Surgeons map out the exact size of the bone wedge they will remove, using an X-ray, CT scan, or 3D computer modeling.
A four- to five-inch incision is made down the front and outside of the knee, starting below the kneecap and extending below the top of the shinbone.
Guide wires are drilled into the top of the shinbone (tibia plateau) from the outside (lateral side) of the knee. The wires usually outline a triangle form in the shinbone.
A standard oscillating saw is run along the guide wires, removing most of the bone wedge from underneath the outside of the knee, below the healthy cartilage. The cartilage surface on the top of the outside (lateral side) of the shinbone is left intact. The top of the shinbone is then lowered on the outside and attached with surgical staples or screws, depending on the size of the wedge that was removed. The layers of tissue in the knee are stitched together, usually with absorbable sutures.
Rehabilitation and prevention
A fall or torque to the leg during the first two months after surgery may jeopardize healing. Patients must exercise extreme caution during all activities, including walking, until healing is complete.
After rehabilitation, preventing osteoarthritis involves slowing the progression and spread of the disease. Maintaining aerobic cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Light, daily exercise is much better for an arthritic knee than occasional, heavy exercise.
It is especially important to avoid any serious knee injuries, such as torn ligaments or fractured bones, because arthritis can complicate knee injury treatment. High-impact or repetitive stress sports, like football and distance running, should be avoided.
Because osteoarthritis has multiple causes and may be related to genetic factors, no universal prevention tactic exists.
General recommendations include:
* Keeping a slight bend in the knees will take the pressure off during standing.
* Avoid activities that causes pain which lasts over an hour.
* Perform controlled range of motion activities that do not overload the joint.
* Avoid heavy impact on the knees during everyday and athletic activities.
* Gently strengthen thigh and lower leg muscles to help protect the bones and cartilage in the knee.
* Non-contact activities keep joints and bones healthy and maintain fitness over time. Exercise also helps promote weight loss, which can take stress off knees.
Osteotomy of the jaw
This is performed to realign the
mandible
In anatomy, the mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human facial skeleton. It forms the lower jaw and holds the lower teeth in place. The mandible sits beneath the maxilla. It is the only movable bone ...
(lower jaw) or
maxilla
The maxilla (plural: ''maxillae'' ) in vertebrates is the upper fixed (not fixed in Neopterygii) bone of the jaw formed from the fusion of two maxillary bones. In humans, the upper jaw includes the hard palate in the front of the mouth. The t ...
(upper jaw) with the rest of the skull and/or teeth. This is usually performed to correct skeletal malocclusions, that is discrepancies in tooth position that cannot be corrected by simple orthodontic movement, and realignment of the
temporomandibular joints
In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the mandible below; it is from these bones that it ...
, or to correct facial deformities such as mandibular retrognathia. There is little scarring, and all of the surgery takes places inside of the mouth.
Orthodontic braces
Dental braces (also known as braces, orthodontic cases, or cases) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are ofte ...
may have to be worn pre- and post- operation to realign the
teeth
A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, tear ...
to match the newly realigned jaw.
Osteotomy of the chin
Chin osteotomy is most often done to correct a vertically short chin. As opposed to putting an implant on top of the chin bone to bring it forward, an alternative approach is to cut the chin bone itself and bring it forward or other directions as well. It can also be used to lengthen the chin (which is more difficult with an implant) or to shorten or narrow a chin. (which is impossible with an implant).
Chin osteotomies (cutting the bone and moving it) are done through an incision inside the mouth. It is technically more difficult than an implant and has more swelling and recovery than a simple chin implant. Also, there is usually temporary loss of feeling of the lip and chin after that takes several weeks to months for full return of sensation.
Veterinary osteotomy procedures
In veterinary medicine, osteotomies are frequently performed to address rupture of the canine cranial cruciate ligament, which is analogous to the anterior cruciate ligament. The
tibial plateau leveling osteotomy TPLO, or tibial-plateau-leveling osteotomy, is a surgery performed on dogs to stabilize the stifle joint after ruptures of the cranial cruciate ligament (analogous to the anterior cruciate ligament CLin humans, and sometimes colloquially called t ...
and
tibial tuberosity advancement Tibial Tuberosity Advancement (TTA) is an orthopedic procedure to repair deficient cranial cruciate ligaments in dogs. It has also been used in cats. This procedure was developed by Dr. Slobodan Tepic and Professor Pierre Montavon at the School ...
are two of the most common osteotomy procedures performed in the United States. Recovery is often 6–8 weeks and the osteotomy can be filled with autologous bone grafts, scaffolds (hydroxyapatite, TR Matrix, etc.) or ceramics.
See also
*
List of surgeries by type
Many surgical procedure names can be broken into parts to indicate the meaning. For example, in gastrectomy, "ectomy" is a suffix meaning the removal of a part of the body. "Gastro-" means stomach. Thus, ''gastrectomy'' refers to the surgical remo ...
References
Further reading
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External links
* NHS Surgery, Theatres & Anaesthesia Specialist Librar
Mandibular Jaw
{{Authority control
Oral and maxillofacial surgery
Orthopedic surgical procedures
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