Osteotomy: Benefits, procedure, and considerations

An osteotomy is a specialised surgical procedure designed to reduce discomfort, improve mobility, and delay or avoid the need for joint replacement.

This article provides a comprehensive overview of osteotomy, explaining the procedure, the recovery expectations, and the lifestyle considerations post-surgery.

Why would I need an osteotomy?

An osteotomy may be recommended for several reasons, primarily to correct bone alignment issues, relieve pain, and enhance joint functionality.

One common reason for an osteotomy is unilateral arthritis (arthritis affecting only one part of the joint). This condition often leads to pain, limited mobility, and joint instability. An osteotomy can realign the affected area, redistributing weight across the joint to reduce pressure on the damaged part and alleviate discomfort.

Another common reason is bone deformities, such as bow-leggedness or knock knees, which place uneven stress on joints. An osteotomy can correct these bone misalignments, improving gait, reducing pain, and preventing further joint degeneration.

What are the benefits of choosing an osteotomy?

An osteotomy offers significant benefits, especially for younger patients or patients who participate in sports. Unlike joint replacement, which replaces the entire joint with an artificial component, osteotomy retains the natural joint and preserves normal movement.

Furthermore, osteotomy can delay the need for joint replacement by several years, providing a better quality of life and maintaining a high level of physical activity. By preserving the natural joint, osteotomy also reduces the risk of needing revision surgery.

How is an osteotomy performed?

An osteotomy is a precision-based procedure that reshapes or repositions a bone to realign the joint. For knee osteotomy, the surgery can be performed as either a high tibial osteotomy (HTO) or a distal femoral osteotomy (DFO).

In a HTO, your knee surgeon will make an incision on the tibia to realign it. The specialist will then either remove or add a wedge of bone, shifting weight away from the arthritic side. This process will redistribute pressure across the knee joint, alleviating stress on damaged cartilage. Your knee surgeon will then stabilise the bone with metal plates and screws to support proper healing in the new alignment.

Similarly, in a DFO, your knee surgeon will reshape the femur to adjust alignment. The specialist will then add or remove a wedge of bone to correct the deformity and balance weight distribution on the knee joint. A DFO is typically performed to treat knock knees.

Osteotomy procedures are typically performed under general anaesthesia and usually last between 1 and 3 hours, depending on the location and complexity of the operation. Your knee surgeon may use imaging techniques, such as X-rays or CT scans, both before and during the surgery to ensure accuracy in bone positioning and alignment.

What is the recovery process like after?

You will have a brief hospital stay, usually lasting 1 to 3 days, during which pain management, initial wound care, and post-operative assessments will be provided. In some cases, you will be advised to use a brace or crutches to immobilise the affected area.

Early in recovery, physiotherapy will play a vital role, focusing on gentle exercises to maintain range of motion and prevent joint stiffness. As healing progresses, physiotherapy will shift toward strengthening the muscles around the joint, particularly the quadriceps, hamstrings, and calf muscles.

Full recovery, including a return to daily routines and moderate physical activity, will take up to 6 to 12 months. Full bone healing and restored strength in the muscles surrounding the joint will continue for several months after that.

Will I be able to return to sports or high-impact activities?

One of the primary reasons patients choose osteotomy instead of joint replacement is the potential to resume high-impact activities (including sports) once the knee has fully healed.

After completing physiotherapy and achieving full recovery, you will be able to resume low-impact activities, such as swimming, cycling, and walking. For high-impact sports like running, skiing, or basketball, the timeline will vary depending on each individual. Clearance from your knee surgeon is essential.

In some cases, your knee surgeon will recommend modifications to your activity to protect the joint from excessive strain, such as avoiding long-distance running or high-frequency jumping. You should work closely with their knee surgeon to determine safe levels of activity that align with your lifestyle and health goals.