Osteotomy Overview

What Is Osteotomy?

Osteotomy is a surgical procedure involving the cutting and realignment of bone to correct deformities, relieve pain, or improve function. The term comes from Greek roots meaning “bone cutting.” Unlike joint replacement, osteotomy preserves the natural joint by changing the bone’s architecture to offload stress, restore alignment, or improve biomechanics.

Sometimes confused with related terms like ostectomy (removal of bone) or osteoplasty (reshaping of bone), osteotomy specifically refers to the precise surgical cutting of a bone. It is commonly employed in orthopedics and dentistry for correction and reconstruction.

X-ray showing bone realignment after successful knee osteotomy surgery

Common Types of Osteotomy Surgery

1. Knee Osteotomy (Tibial or Femoral Osteotomy)

Used to treat unicompartmental knee osteoarthritis or malalignment:

• High Tibial Osteotomy (HTO): The most frequent knee osteotomy, where the tibia (shinbone) is cut and angled to shift weight away from damaged cartilage.

• Distal Femoral Osteotomy: Cutting the femur to correct alignment.

This surgery delays or avoids knee replacement by redistributing joint load.

2. Hip Osteotomy

Performed to correct congenital or acquired deformities of the hip joint, improving hip function and preventing arthritis progression.

3. Foot Osteotomy

Includes various procedures, such as:

• Cotton Osteotomy: Elevation of the medial cuneiform bone in the foot to correct flatfoot deformity.

• Metatarsal Osteotomy: Cutting and realigning the metatarsal bones to correct bunions or other deformities.

• Calcaneal Osteotomy: Adjustment of the heel bone to correct alignment issues like flatfoot or heel valgus.

4. Jaw (Mandibular or Maxillary) Osteotomy

Used in orthognathic surgery to correct jaw misalignment or facial asymmetry.

5. Other Named Osteotomies

• Dwyer Osteotomy: Correction of heel deformities.

• Ludloff Osteotomy: Used in hallux valgus (bunion) surgery.

• Various wedge osteotomy techniques involve removing or adding a bone wedge to change angles.

What Happens During Osteotomy Surgery?

• First, your surgeon makes one or more precise bone cuts with specialized instruments (e.g., osteotome, saw).

• Then, the bone is repositioned or realigned to the desired angle or length.

• Fixation devices like screws, plates, or external fixators are applied to stabilize the bone during healing.

• Sometimes bone grafting is done to enhance healing.

• Surgery duration, invasiveness, and recovery vary widely depending on the site and complexity.

What Happens When Screws Are Removed From Bones?

If hardware removal is necessary, screws and plates are surgically extracted once healing is complete (often after 6–12 months). This is generally a minor procedure but depends on the initial osteotomy location and healing progress.

Recovery After Osteotomy Surgery

• Recovery times depend on the osteotomy site and patient’s health.

• Weight-bearing restrictions are common initially, followed by graduated physical therapy to restore strength and mobility.

• Pain management, wound care, and monitoring for complications (infection, nonunion) are crucial.

• Full healing typically takes 3–6 months; some osteotomies (e.g., knee) may require longer rehabilitation.

Indications for Osteotomy

Osteotomy is ideal when joint preservation is desired, especially in:

• Early-to-moderate osteoarthritis, where alignment correction can delay joint replacement

• Congenital deformities or acquired malunions

• Limb length discrepancies or angular deformities

• Foot deformities like bunions or flatfoot

• Facial or jaw abnormalities requiring realignment

Surgical view of wedge osteotomy realigning joint surfaces

Osteotomy vs. Osteophytectomy and Ostectomy

• Osteophytectomy is removal of bone spurs to relieve joint impingement.

• Ostectomy indicates surgical removal of bone, a broader term than osteotomy.

• Osteotomy is specific realignment, often combined with other procedures for comprehensive treatment.

Osteotomy Surgery Cost & Considerations

Costs vary widely based on:

• Location and healthcare system

• Complexity of the procedure

• Technology and fixation hardware used

• Hospital stay duration

Patients should consult orthopedic specialists for detailed estimates and coverage options.

Conclusion: Is Osteotomy Right for You?

Osteotomy is a powerful, joint-preserving surgery that can significantly improve pain and function in patients with deformities or early arthritis. Advances in surgical techniques and postoperative care continue to enhance outcomes.

If you are struggling with persistent joint pain or deformity, discuss osteotomy options with an experienced orthopedic surgeon to tailor a personalized treatment plan.