An Osteotomy is a surgical procedure of bone in which the bone is modified, cut or reshaped to correct an alignment or deformity. The deformity may result due to trauma or disease. Osteotomy may also be used to shorten or lengthen the deformed bone. The main focus of this surgery is to relieve pain in arthritis, hip or knee. This may help to postpone the total joint replacement for few years for younger people.
An Osteotomy aims to reduce the Osteotomy gap and ensure accurate alignment and proper fixation for which internal or external fixation may be used. At the same time, it also ensures that the soft tissues are safe and protected.
Types of Osteotomy
Osteotomy can fix various problems of different bones and joints like:
- Hip: This surgery involves reshaping the hip socket to better cover the ball of hip joint.
- Knee: During the knee Osteotomy, knee deformities such as a kneecap which is not straight and painful worsened by arthritis are corrected. This surgery takes pressure off the damaged side of the knee joint by cutting or reshaping the tibia or femur.
- Spine: In this surgery, a wedge-shaped piece of bone from the spine will be removed to correct a swayback.
- Jaw: Osteotomy of jaw moves lower jaw to another position. The operation is also used to correct other jaw problems like maxillary prognathisms, mandibular prognathisms, open bites, difficulty in chewing and difficulty in swallowing.
- Big toe: A segment of bone will be removed from the big toe to straighten it from jamming with other toes.
- Chin: Chin Osteotomy is done to correct a short chin.
- Elbow Osteotomy: Osteotomy is done to correct elbow fractures posttraumatic deformities.
After the Osteotomy, a biomechanical alignment of the extremity with an increase in the contact area or improved joints will be observed. Osteotomy is able to correct following deformities:
- Valgus or varus angulation
- Anterior or posterior angulation
- Internal or external rotation
- Lengthening or shortening
- Medial or lateral shift
- Dorsal or ventral shift
- The patient’s signs like blood pressure, heart rate, body temperature, and oxygenation levels are normal and surgery can proceed. The patient may need to undergo: X-ray, CT scan, or 3D computer modeling.
- A patient will receive general anesthesia and put to sleep, also be given a regional anesthesia to block sensation from the waist down along with a relaxant. However, the type of anesthesia patient receive must be decided well ahead of time.
- The surgeon will check the joint to confirm if there is any significant cartilage damage on the “good side” of the region. This can be done arthroscopically right before the procedure.
- An antiseptic or anti-microbial skin cleansing regime may be recommended by some surgeons prior to surgery.
- Two weeks before surgery, the intake of these medications may be discontinued:
- Aspirin, NSAIDS like Aleve, Advil, or any ibuprofen, and other medications that make it more difficult for blood to clot
- Steroids and other medications that suppress the immune system, and therefore, may increase the chance of post-surgical infection.
- Smoking also must be avoided at least few weeks before surgery, since nicotine affects the healing process slowing it down. It also increases the risk of blood clot that may form in a deep vein, post-surgery.
- In case of other medical issues such as heart problems or diabetes, medical clearance from the surgeon and primary care physician may be required, to verify that the patient is fit enough for anesthesia and surgery.
- Patients who have more than 1 or 2 alcoholic drinks per day inform doctor because heavy alcohol use can impact the effects of anesthesia.
- Any infections such as cold, fever, flu, herpes before surgery must be reported to the surgeon.
- Patients with medical preparations should improve the likelihood of a successful recovery.
It can be a complex surgery and is mostly done with general anesthesia. The patient therefore mostly sleeps through the entire surgery. If the area of the surgery is in the lower half, a spinal tap can be chosen in which the patient is not unconscious and only the lower part of the body below the waist feels numb. The surgical team sterilizes the part with an antibacterial solution after anesthesia administration.
- First, the exact size of the wedge of the bone to be removed is demarcated. This is done with CT scan, X-ray or using 3D Computer Modelling.
- The surgeon will make 4-5 inch incision with a bone saw in deeper soft tissue, such as muscle, to expose the bone to be altered
- Then the wedge of the bone that is located close to the damaged joint is removed.
- As a result, the weight is shifted from the area where the cartilage is damaged to the area of healthy or normal cartilage.
- The surgeons approach every joint differently. The new alignment is cross-checked by the surgeon and accordingly, the size of the wedge is adjusted.
- The bone will be pushed together and screws and metal plates are used to secure the newly altered bone.
- The surgeon may close up the surgical wound if it is a closed Osteotomy after removing the wedge of bone. The surgeon may use a tool to gently tap the wedge into place.
- In an open Osteotomy, a wedge-shaped bone graft is planted into the cut bone.
- Finally, the entire procedure helps in even distribution of weight across the cartilage of the joint.
Preparation will decrease stress and anxiety when arriving home. Mostly the household preparations are done beforehand reduce the chance of falls and help to avoid jeopardizing a successful recovery.
- During the hospital stay, the patient is guided about self-care, especially the wound, once he or she is on his/her own at home. The patients learn how to change bandages and take care of the wound while bathing. Cleaning the wound thoroughly helps to keep away infection.
- Need to arrange for a caregiver, spouse or a friend to look after, take care of meals and other household chores.
- Need to arrange for transportation, as most patients cannot drive for the first 6 to 8 weeks after surgery.
- For knee Osteotomy patient, it is essential to keep ready-made meals and other essentials in stock to avoid the emergency rush for small errands after surgery.
- Pain medication will be given in the hospital and prescribed for after discharge. If at any time pain is not being controlled well with medications, patients should talk to their doctor. If addressed early, Pain can be easily managed.
- In the first two weeks following the surgery, steps must be taken to reduce swelling near the wound. Exposure to the sun, scrapes and poison ivy must be avoided to prevent adverse effects on the area surrounding the wound.
Risks involved in Osteotomy
- Artery damage
- Blood clots
- Bones that don’t heal as expected
- Chronic pain
- Issues with anesthesia
- Joint stiffness
- Nerve damage
- Scar tissue
Factors affecting the cost of Spinal Instrumentation
- Surgical team fee
- The type of anesthesia
- Hospital stay
- Types of Osteotomy procedure