Osteotomy: an expert guide

Osteotomy is a surgical procedure that can repair damaged joints by cutting the bone. It can postpone a knee replacement, or even eliminate the need for one. In his latest article, renowned consultant trauma and orthopaedic surgeon Mr Cristian Nita explains this procedure in detail.

What is an osteotomy?

An osteotomy is a medical term for creating a controlled fracture in a bone. It is a tried and tested technique, with records of the procedure reaching back to ancient Egypt.

We use osteotomy in recent years as a means to preserve joints. It is very common in foot surgery, hand surgery and in the last 10 – 15 years it is regaining popularity in knee surgery. We use it to restore alignment in the limb and hopefully postpone knee replacement surgery. If we catch these patients soon enough, they may not need a knee replacement in the future at all.

How is it performed? Is it dangerous?

Surgery in general comes with risks, but in the right hands, with the right training and tools, these are calculated risks. It is performed with special equipment. We use software nowadays to plan osteotomies. We take specialist x-rays involving hip joints, knee joints and ankle joints, while the patient is standing at a certain distance. The software can calculate the angles of the lower limb and compare them to what is normal.

We then calculate precisely how to proceed in realigning the lower limb. Knee joint osteotomy can be done in the distal femur, in the proximal tibia or both. We use very specific tools in the operating theatre, and a solid knowledge of anatomy and the procedure itself is required.

At my practice, we offer training for future osteotomy surgeons and senior trainees or fellows. We are keen to help future generations take on this surgery. We believe this procedure is a very good tool for reducing the number of joint replacements and preserving the natural joint.

Will I need a follow-up after my surgery?

Yes, following an osteotomy procedure, there are 3 specific milestones we are keen to monitor. Usually, two weeks following the surgery we take x-rays in which we look at the means of fixations (plates and screws) and make sure everything is alright. We also have a look at the hinge that was created when the bone was cut during the procedure (the bone is not cut fully, which creates this hinge). The hinge is checked with an x-ray, and if there are no complications, we encourage the patient to begin fully weight-bearing with crutches after 4 weeks.

After three months, we expect that the patient has resumed all of their physical activities and we encourage and allow them to progress to more intensive physical activities. After a year, some patients choose to have the plates and screws removed. A low percentage of patients I see at my practice choose to do this if these plates and screws are creating local discomfort or skin irritation. Most patients do not need to get them removed.

In terms of results and benefits, what can I expect?

It is difficult to persuade the patient to break their leg to make it straighter, in order to prevent knee replacement surgery later on down the line. Having a patient who is on board and open in terms of perception is very important. The benefits are slower to come than with a knee replacement procedure, but patients see a slower and continued improvement for up to two years following the procedure. This depends on how bad the deformities were to begin with.

Mr Cristian Nita is a renowned consultant orthopaedic and consultant trauma surgeon with over 20 years of experience. If you would like to book a consultation with Mr Nita you can do so today via his Top Doctors profile.