What is osteotomy for?
Osteotomy is the name of a surgical operation that involves the excision of a bone, with the aim of shortening it, lengthening it or changing its shape.
Sometimes, the osteotomy is performed to treat the hallux valgus or to correct a wrong bone welding (occurred in healing after a fracture); in other circumstances, it may be useful in the treatment of coxa vara (hip deformity), valgus knee and varus knee.
The operation is always performed under regional (spinal or epidural) or general anesthesia.
The osteotomy is traditionally also used as a remedy for the pain of arthritis, particularly that of the hip and knee; today, especially in elderly patients, it is often replaced by the installation of joint replacements.
Prognosis and healing after osteotomy
Being particularly invasive and sometimes complex, the osteotomy requires a long and sometimes difficult recovery. For a correct post-operative recovery it is necessary to consult the doctor, who will plan carefully all the details necessary for recovery.
In this phase, tools are often used to optimize healing and improve the lifestyle of patients who need a load reduction / adjustment; for example: shoehorns, hooks, extenders, etc.
Types of Osteotomy
Coxofemoral osteotomy
The hip osteotomy is used to improve the alignment and interaction of the acetabulum with the femoral head, correcting any dysplasia and deformity of the hip.
This procedure is performed mainly in two ways: innominate osteotomy and femoral osteotomy, in which the bones are cut, reshaped or partially removed, realigning the supporting surfaces of the joint.
Hip osteotomy
Coxofemoral surgery is generally performed on the hip side. This surgical operation can be practiced in various ways, which are classified according to the cut (for example Chevron and Wedge) and to the correction (for example Dial).
Many acetabular procedures are named after the surgeons who first experimented with them, such as Salter (R. Salter), Dega (W. Dega), Sutherland (DH Sutherland), Chiari (K. Chiari); other names are Ludlov, P. Pemberton and James B. Steele.
Osteotomy of the femur
Femoral osteotomies, as the name indicates, involve a correction made on the femoral head (proximal epiphysis) and / or the rest of the bone (body / diaphysis or distal epiphysis).
Knee osteotomy
Knee osteotomy is commonly used to realign arthritic damage (disappearance of cartilage with possible superficial bone degeneration) affecting only one side of the knee.
The aim of the operation is to redistribute the body weight, reducing it on the damaged site and favoring the opposite side of the joint, where the cartilage is still in good health. The surgeon performs this procedure by removing a wedge (bone segment) from beneath the epiphysis of the tibia, allowing it to interact correctly with the femur. Often this correction also requires the proportional shortening of the fibula.
To be clear, the space left by the removal of the wedge is similar to that remaining on the hinges of a door when it is opened.
Image from wikipedia.org
Osteotomy is also used as an alternative treatment to total knee replacement in younger arthritic patients. Because prosthetic knees can become inadequate over time, an osteotomy procedure can allow these people to continue using their knees on the healthy side, delaying the implant for up to ten years.
How does the osteotomy of the knee occur?
The position of the removed wedge depends on that of the damaged tissue. The most common type of osteotomy performed on the arthritic knees is the high-tibial one, which deals with the damage of the cartilage on the internal (medial) part of the joint. The procedure usually lasts 60-90 minutes.
During a high-tibial osteotomy, surgeons remove a bone wedge from the outside of the knee, emphasizing the internal flexion of the leg; it is very similar to the realignment of a varus knee. The patient's weight is then transferred to the outer (lateral) part of the knee, where the cartilage is still in good health.
After epidural or general anesthesia, the surgical team sterilizes the leg with an antibacterial solution. Surgeons trace the exact dimensions of the cuts using an X-ray, CT or 3D system. An incision is then made 10-13 centimeters in front and outside of the joint, under the patella, in the upper part of the tibia.
Subsequently, some guiding traces are applied superficially to the bone, after which the surgeon proceeds with the cutting of the wedge using a saw. The opposite surface of the bone head is left intact. The interrupted vertices are then connected with surgical screws or other tools, depending on the size of the removed wedge. The overlying soft tissue layers are finally sewn together, usually with absorbable sutures.
Knee osteotomy: rehabilitation and conservative prevention
A fall or a twist in the leg during the first two months after surgery can compromise healing. Patients must be extremely cautious during all activities, including walking, until complete recovery.
After rehabilitation, the prevention of degeneration on the healthy surface of the knee begins. This involves slowing the progress and spread of the disease.
It seems that motor physical exercise, particularly aerobic cardiovascular exercise, is an effective method to prevent the progression of osteoarthritis. The light and daily activity is much more effective than the discontinuous and occasional one.
It is particularly important to avoid any serious knee injury, such as broken ligaments or bone fractures, as arthritis can complicate healing. Sports characterized by repetitive stress (such as cross-country running) and physical contact (rugby, soccer, etc.) should be avoided.
Since osteoarthritis is multifactorial and may be related to genetic factors, there is no universal prevention tactic. General recommendations include:
- Maintain a slight flexion of the knees to decrease pressure during the standing position.
- Avoid all activities that cause pain and last more than an hour.
- Perform a controlled series of activities and movements that do not excessively stress the knee.
- Avoid overloading the affected joints during daily and athletic activities.
- Lightly strengthen the thigh and leg muscles to protect the bones and cartilage in the knees.
- Practice appropriate physical exercise which, in addition to maintaining the health of the knees, promotes weight loss by reducing the load on them.
Osteotomy of the maxilla-mandible
The maxillary-mandibular osteotomy is performed to realign the mandible or maxilla to the rest of the skull. It may be essential to correct skeletal type occlusion, that is the discrepancies in the position of the teeth that cannot be corrected by simple orthodontic movements and realignments of the temporomandibular joints, or to correct facial deformities such as mandibular retrognathia.
This surgery is characterized by poor healing and the whole procedure takes place inside the mouth. Orthodontic appliances can be worn before and after the operation, in order to realign the teeth adapting them to the new jaw / jaw position.
Chin osteotomy
Chin osteotomy is used to correct a vertically short chin. Instead of installing an external implant at the vertex of the bone to lengthen the profile, an alternative approach can be chosen, cutting a flap of the same and positioning it forward or in other directions. This system can also be used for a simple reduction.
Chin osteotomies are performed through an incision inside the mouth. They are technically more difficult than the implant and cause more swelling. Furthermore, they cause temporary loss of sensitivity of the lower lip and chin, which reappear only after a few weeks or months.
Curiosity: veterinary osteotomy
In veterinary medicine, osteotomies are often performed to deal with rupture of the cervical ligament of the dog's skull, similar to the anterior cruciate ligament.
