Osteotomy

Overview of Osteotomy in India

An osteotomy is kind of a surgical procedure where bones are cut and reshaped because of the presence of a certain disease. In some cases, specific diseases attack the bone structure and also mess with the joints. In these situations, the surgeon takes away the injured or damaged portion of the bone while keeping the healthier bone parts in place. Osteotomy can also be used to fine-tune the length of bones on both sides, so the balance is better. Plus, this procedure is sometimes done in younger people, not just for serious joint damage, but to delay the time when joint replacement surgery becomes necessary.

There are a lot of types of osteotomy, and each one is chosen based on the kind of joint that’s involved, plus what’s happening because of the disease.

Overall, osteotomy is not a simple task. It needs the right plan, post-operative care, and ongoing management. There are many hazards and possible complications that should be prevented, so the patient doesn’t face issues during or after the surgery. When diseases of the bones and joints progress, they can really limit a patient’s quality of life. So a good rehabilitation program is important to help people return to regular daily living activities. To make that happen, physical therapists and occupational therapists work together, and they properly design an exercise approach for each patient, separately, to support independence and better function.

What Is An Osteotomy?

An osteotomy is a surgical procedure where the surgeon cuts a bone (in some cases, adding bone) to reshape or realign the bones.

Your surgeon may perform osteotomies of any of the bones in your body, including your jaw, elbow, spine, shoulder, hips, knees, legs, toes and feet, and it is used to treat problems in the joints (the area where two bones join together).

There are many types of osteotomy techniques and variations of those techniques. They are generally named by the name of the surgeon who developed the technique, or by how the bone is shaped or realigned.

Types of Osteotomy:

Depending on the location and outcome of the cut in the bone, there are many types of osteotomies to choose from. Some examples of osteotomy types include:

Wedge Osteotomy: A wedge-shaped piece of bone is surgically removed from a bone to align two parts of the bone; then, to assist the bone to heal properly and as intended, both pieces of bone will be realigned and held together with surgical plates (i.e., metal) and screws.

Chevron Osteotomy: An angular section cut into the bone creates a “V” shape, allowing the surgeon to realign and fasten the two portions of the bone.

Dome Osteotomy: A circular cut into the bone allows the surgeon to rotate the bone and fasten the two ends of the bone or limb, which of those bone operations can include knees, elbows, etc.

Procedure:

The​‍​‌‍​‍‌​‍​‌‍​‍‌ osteotomy procedure comprises several major phases that focus on realigning the bone and fixing particular orthopedic disorders. Below is a summary of each stage:

Preoperative Planning:

Surgical preoperative planning typically starts with the orthopedic surgeon`s diagnostic work-up, comprising a physical examination and diagnostic imaging such as X-rays or MRIs. This helps in the visualisation of the precise site and nature/type of osteotomy needed.

Anesthesia:

Anesthesia is administered to the patient. The forms of anesthesia available include: general (patient is completely unconscious) or regional (only the area of operation is numbed). Deciding factors for the type of anesthesia include the patient's physical status and the kind of osteotomy being performed.

Incision:

Initially, the surgeon will make cuts through the skin on the surface of the bone to be operated upon. Planned incision size and area location are influenced by the particular type of osteotomy to be done.

Bone Cutting and Reshaping:

Osteotomy involves surgical cutting of the bone with the use of specially made surgical instruments that are capable of both precision and control. With the intention of making corrections, the bone will undergo different processes such as segmentation (made into pieces), repositioning, and after that, secured through different fixation methods. The method used for changes on the bone depends on the targeted outcome of osteotomy, e.g., high tibial osteotomy involves cutting and repositioning of the tibia in order to reduce load on the knee joint.

Stabilisation:

After the bone has been shifted to its new position, the next step is fixation/stabilisation with the help of attachment devices - plates, screws, or pins. They will also serve the new bone configuration and maintain it throughout the period of healing. 

Closure:

The incision will be closed with the help of skin sutures or skin staples, and in certain cases, the surgical area will be given drainage tubes, which will help in the removal of any excess fluid or blood.

Postoperative Care:

Patient`s post-surgery monitoring is carried out in a recovery room and the patient may have to remain in the hospital for a short time. Main postoperative care points are pain control, infection avoidance, and detection of complications.

Rehabilitation:

Physical therapy and rehabilitation form the major parts of the recovery phase. The patient will be guided by a physical therapist to work on strengthening, regaining range of motion, and functional recovery. Rehabilitation programs vary according to the type of osteotomy and patient needs.

Follow-Up:

The healing progress, bone alignment, and treatment modifications are frequently done through scheduled follow-up visits. X-rays are commonly done to verify proper bone healing and ​‍​‌‍​‍‌​‍​‌‍​‍‌fixation.