Osteotomy: Purpose, Procedure, Benefits and Side Effects

Osteotomy is a type of surgical procedure used to help treat a wide range of musculoskeletal issues. It involves cutting and removing sections of bone, often to correct problems associated with abnormal joint alignment or abnormal motion in the affected area.

As there are several types of osteotomy, here are some examples:-

• Subtrochanteric Osteotomy: This type of osteotomy is usually performed on the femur (thighbone) to improve alignment of its ends in patients with hip deformities or joint disorders.
• Femoral Osteotomy: This procedure corrects displacement and malalignment within the parts of the femur, and is generally done to treat difficult femoral fractures.
• Pelvic Osteotomy: This operation helps realign the pelvic structure and can be used to treat pain experienced during weight-bearing activities due to structural issues with the hip joint.
• Calcaneal Osteotomy: This type of surgery is performed on the calcaneus (heel bone) for correction of morton's neuroma, which is caused by impingement between nerve branches in the foot due to bone misalignment or malrotation in this area.
• Knee Joint Osteotomy: A knee joint osteotomy may be done on either one side or both sides of the knee joints, depending on what part needs correction, such as malalignment that has caused deformity or pain due to arthritis or other external factors.

• Improved Joint Alignment: Osteotomies can help improve the alignment between a joint's bones and muscles, leading to increased mobility and decreased levels of pain. This is particularly beneficial for people suffering from conditions such as hip dysplasia, flatfoot deformities and arthritis.
• Alleviation of Pain: By reducing joint pressure on pinched nerves or other irritated tissues that may lead to pain, osteotomies can often provide an effective form of relief when medication is ineffective or not an option due to side effects.
• Enhanced Mobility: Osteotomies may restore range of motion in stiff joints through improved alignment and overall balance in the affected area. This improved mobility makes it easier for people affected by musculoskeletal issues to live active lives with greater independence.
• Reduced Wear-and-Tear on Joints: By redistributing weight across joints through realignment, osteotomies keep strain levels lower which reduces overall wear-and-tear on the involved joints over time - saving patient’s hips from being replaced prematurely due to excess stress on them resulting from poor alignment or displacement conditions (such as inflamed ligaments).
• Reduced Risk of Injury: Through improving joint movement dynamics an osteotomy can reduce the chances for tendon tears, fractures and other forms of injury associated by poor movement patterns during activity .

Osteotomy can be used to:-

• Correct joint malalignment (also known as angular deformities)
• Reduce pain and improve mobility by realigning bones to better distribute load and stress from one side of the joint to another.
• Relieve pain from arthritis by restoring normal articular surface contact between bones, which may help reduce arthritic symptoms.
• Reduce stress on tendons or joints when there is a large amount of soft tissue involved or if the joint is significantly damaged due to trauma or disease.
• Provide support for reconstruction after trauma, removal of tumours or leg length discrepancies (unequal length legs).

• Infection: If a wound becomes infected, it can cause severe damage and delay healing.
• Injury to blood vessels and nerves: There is a risk of injury to the blood vessels and nerves near the incision site. This can lead to loss of sensation or vascular complications such as bleeding or lack of blood supply, leading to tissue death.
• Damage to bones or cartilage: During some osteotomies, bones are cut apart and then put back together with plates and screws that hold them in place until they heal together. If these joints aren't precisely re-aligned, there is a risk of arthritis developing later in life due to instability in joint movement after healing has occurred.
• Blood clots: Blood clots can form deep within the veins or circulatory system as a result of surgery, which can lead to serious medical complications if left untreated.

Preparing for an osteotomy can be complex, but there are several steps you can take to ensure you have the best outcome possible:-

• Speak to your doctor and surgeon about your specific medical history, as well as medications and supplements you are currently taking. Be open and honest with your doctor so they can adjust treatments accordingly.
• Ask questions about the procedure and ensure you understand both the risks and benefits of an osteotomy.
• Have tests done ahead of time such as X-rays, MRIs, etc., so that the doctors have a clear picture of your bone structure before surgery begins.
• Prepare for recovery in advance, including stocking up on healthy food that will help with healing. There may also be certain activities or exercises outlined by your doctor that should be done prior to surgery to help reduce bleeding or muscle soreness after surgery is complete.
• Carefully follow any instructions given to you regarding diet or medication restrictions prior to surgery, as recommended by your physician or surgeon.

Osteotomy is a surgical procedure involving the cutting and repositioning of pieces of bone to alter their alignment. During an osteotomy, small sections of bone are accessed via an incision, then carefully removed and shifted into new positions. Pieces of metal plates or screws may be inserted to help maintain the desired shape before the skin layers are sutured together over the incision site.

• The patient must have a preoperative consultation with a physician to determine if they are a suitable candidate for the procedure.
• Preoperative medications may be required for pain management or other reasons as determined by the physician.
• Local, general or spinal anaesthesia can be administered depending on the type and location of the surgery.

• After appropriate anaesthesia has taken effect, an incision will be made at the site intended to correct deformities that have been identified in imaging scans or on physical examination by a physician prior to surgery.
• Bone segments will then be cut and repositioned according to surgeon’s guide measurements and anatomical landmarks in order to realign them correctly together with adjoining bone fragments if needed.
• Finally, screws, plates or wires may be used to secure each segment into place before closing up incision wounds with sutures or staples and covering it up with dressings afterwards as needed.

• The bandages over incisions should remain unchanged until directed otherwise by medical professionals.
• Patients may require physical therapy for regaining strength after surgery depending on guidance from the medical team.

The cost of osteotomy in India will vary and is dependent on the type of surgery being performed, the hospital where the procedure is being performed, and any additional treatments or medications that may be necessary. Generally speaking, the estimated cost of an osteotomy in India can range from around Rs. 50,000 to Rs. 2 Lakhs.

• Soft, easy to digest foods such as soups, plain cereals, boiled potatoes and soft-cooked eggs.
• Soft fruits like bananas and melon, cooked vegetables and lean protein sources such as fish, chicken or tofu.
• Dairy products like yoghurt and smoothies are great for calcium fortification.
• Avoid acidic foods like citrus fruits and tomatoes that could irritate the surgical area, processed meats, spicy foods and sugary snacks.

Yes, Osteotomy is generally considered a safe procedure when performed by an experienced orthopaedic surgeon. It is an effective tool for treating skeletal deformities and traumatic fractures.

• Osteotomy can be a very painful type of surgery. During the surgery, because bone is cut and reshaped to alter body structures, it can be quite uncomfortable or even painful.
• Pain after the surgery can last a few days to weeks and can be managed with prescription medications.
• Additionally, physical therapy and exercise may help reduce pain and speed up the recovery process.

Generally, patients who undergo an osteotomy require 4-6 weeks of recovery time before they are completely able to resume their normal daily activities. In very complex cases, recovery time may be more lengthy (up to 6 months).

• Pain and discomfort in the immediate postoperative period.
• Blood loss and infection at the surgical site.
• Nerve or blood vessel damage.
• Joint stiffness, swelling or soreness.
• Possible complications from general anaesthesia or local infiltration anaesthesia use.
• Imbalance of the muscles around the operated area leading to altered posture.
• Long-term joint stiffness, instability, and arthritis in some cases.

• Wear supportive braces or casts as recommended by your doctor.
• Protect the surgical area from knocks, bumps and scrapes that can cause damage or discomfort.
• Avoid strenuous activities and contact sports while recovering.
• Follow the recovery and exercise regimen prescribed by your doctor to encourage healing of the bones and surrounding tissues.
• Take medications as recommended to prevent infection and reduce pain levels as needed for comfort.
• Get adequate rest throughout the recovery period to allow body time needed for tissue healing process-progressively increasing activity levels as directed by physician or physical therapist (if necessary).
• Attend regular follow-up visits with your surgeon or specialist, in order to assess level of healing, determine if any interventions need adjustment, properly adjust supports/braces/casts (where applicable for structural support), etc.

Osteotomies can be a beneficial way to treat musculoskeletal conditions, serving as an effective alternative to more invasive surgical procedures. With new technology, specialised implants and advanced techniques, osteotomy has become a safe and effective way to alleviate the pain of certain orthopaedic conditions. Patients should always talk to their orthopaedic surgeon about all options available so that they can make an informed decision about which procedure or treatment is right for them.