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Osteotomy for Osteoarthritis

Surgery Overview

Osteotomy ("bone cutting") is a procedure in which a surgeon removes, or sometimes adds, a wedge of bone near a damaged joint. This shifts weight from an area where there is damaged cartilage to an area where there is more or healthier cartilage.

In osteoarthritis, cartilage breakdown in the knee often is much greater in the inner part of the knee joint, often resulting in a bowlegged appearance. Surgery to shift the weight away from the inner knee is one of the most common uses of osteotomy for osteoarthritis. The idea is to tilt your body weight toward the outer, healthier part of the knee cartilage and away from the inner, damaged cartilage. Weight is then spread more evenly across the joint cartilage. The surgery may be done in one of several ways. It may be done on the thighbone (femur) or the large lower leg bone (tibia).

The most common way to use osteotomy for osteoarthritis of the inner knee is to remove a wedge of bone from the outer side of the large lower leg bone (tibia) near the knee. After removing the bone wedge, your surgeon will bring together the remaining bones and secure them, most often with either pins or staples.

Osteotomy for osteoarthritis of the inner knee could also include adding a wedge of bone to the inner tibia, or adding or removing bone from the femur. Osteoarthritis of the outer knee is treated in just the opposite way. For example, your surgeon may remove bone from the inner side of the lower leg to shift the weight toward the inner knee.

Osteotomy may be effective for hip and knee joints. Doctors often do an osteotomy to correct certain knee deformities such as bowleg (varus) and knock-knee (valgus) deformities of the knees. Hip osteotomy involves removing bone from the upper thighbone (femur). Osteotomy may allow an active person to postpone a total joint replacement for a few years and is usually reserved for younger people.

What To Expect

Recovery depends on the surgical technique as well as the strength and motivation of the person having surgery. A cast or splint may limit movement of the joint for 4 to 8 weeks.

You will start physical therapy immediately, even if you are in a cast or splint. When the cast is removed, you can put your full weight on the joint 10 to 12 weeks after the surgery. It may take up to a year for the knee to fully adjust to its corrected position.

Why It Is Done

Doctors use osteotomy if destruction of the knee cartilage mainly affects a single disc of cartilage: the disc (meniscus) either on the inner part or on the outer part of the knee joint.

Osteotomy is an appropriate treatment for younger, active people with osteoarthritis who are able to delay a total joint replacement.

How Well It Works

Osteotomy is most often done in younger people. It can help relieve pain and delay the need for joint replacement.footnote 1

Risks

  • A failure of the bones to heal
  • Bones that don't align as they heal
  • Blood clotting
  • Bleeding in the joint
  • Inflammation of joint tissues, nerve damage, or infection

What To Think About

By shifting the weight onto good cartilage, osteotomy may "buy time" for younger or more active people before they need a total joint replacement.

References

Citations

  1. Lozada CJ (2013). Treatment of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology 9th ed., vol. 2, pp. 1646-1659. Philadelphia: Saunders.

Credits

ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine

Current as ofNovember 29, 2017


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