Osteotomy Surgery in Delhi, India

A surgical procedure with which the bone is reshaped to allow for re-alignment is called an osteotomy. This procedure helps repair a damaged joint. It can also help shorten or lengthen a deformed bone that fails to align with the joint as it should. This procedure requires meticulous planning during the recovery period. The procedure is carried out under general anaesthesia. The purpose of osteotomy differs based on the location of the affected joint

Osteotomy can be done in both young individuals and older citizens. This procedure can help postpone a hip or knee surgery for many years. In addition, it helps relieve pain and restores the function of the affected joint.

Types

Osteotomy can fix problems in many different bones and joints. For instance:

• Hip: During surgery, a doctor will reshape the hip socket to cover the hip joint's ball better
• Knee: A kneecap that is not aligned well, causing pain and can worsen with arthritis. During a knee osteotomy, either the tibia (upper shinbone) or femur (lower thigh bone) is cut and reshaped. This lowers the pressure on the injured side of the knee joint
• Spine: A wedge-shaped piece of bone taken from a section of the spine can be cut and removed to reduce a hunchback or correct a swayback
• Jaw: When the bones of the face don't align with the bite of the teeth, osteotomy of the lower jaw (mandible) can help move the jaw to a new position and change a person's aesthetic appeal. It can also be done when placing dental implants in order to alter the bone surface to accommodate the implant
• Big toe: A segment of the bone can be removed from the big toe to straighten it and prevent jamming into the other toes
• Chin: Plastic surgeons sometimes use osteotomy to narrow a broad or square chin for a better esthetic look

When is surgery needed?

Generally, people under 60 years old, active, and overweight are considered appropriate candidates for osteotomy. It is mainly done to:

• Correct the excessive angulation, rotation, or bowing of long bones
• Correct the mal-alignment of a joint that may have occurred due to malunion or deformities like coxa vara, genu varum, and genu valgum
• To relieve pain in cases of arthritis, especially of the hip and knee.
• Particular indications where osteotomy is performed for purposes other than above, e.g., McMurray's osteotomy.

Diagnosis

Specialists take a thorough medical history to assess any pre-existing medical conditions. Certain tests that may be advised are:

• Routine blood tests to rule out infections, haemoglobin level, blood group
• Liver and kidney function tests
• Urine tests
• X-rays
• CT scans
• MRI (rarely)
• Detailed assessment of heart function for elderly patients

Treatment

Osteotomy can be a complex procedure. In most cases, one needs to be admitted to the hospital. The doctor first discusses the options for anaesthesia appropriate for a given joint, and consent is obtained. For instance, the patient may choose a spinal tap for osteotomy involving the lower bones of the body (e.g., knee) so that they are awake but feel numb in the lower half of the body. Similarly, the patient may be administered local anaesthesia for minor procedures such as the toe.

Osteotomy Procedure

First, the patient is put under anaesthesia. Then, the skin is incised to access the area of bone on which the surgery has been planned. Next, special guide wires are used to measure the bone, after which a section of the bone is removed using a surgical saw. 

The new, open space is filled with bone grafts or bone chips. Small screws and metal plates are used to hold the bone in place and can be taken out once the bone heals. In some cases, they are left within permanently.

The bone grafts can be allografts or autologous bone grafts taken from a bone bank or a wedge removed from the pelvis. Metal hardware can also help hold the bones in place. Once the surgery is done, sutures are placed, and the patient is sent to the recovery room. Once the patient is conscious, they are shifted to the normal room.

Who are the best candidates for surgery?

The best candidates for an osteotomy procedure are those who:

• Are relatively young - between the age group 40 to 60 years
• Are not obese
• Have mild to moderate arthritis. This condition should be affecting only one side of the knee and little to no damage on the other side.
• Good knee movements
• Experiencing significant arthritis pain brought on by activity or standing for an extended period of time
• Want to stay physically active—also, those who are willing to commit to a long post-surgical physical therapy regimen.
• Can use crutches and limit weight bearing for about 6 to 8 weeks after the surgery is performed

Who should not consider surgery?

• Osteotomy is contraindicated in patients with rheumatoid arthritis, inflammatory arthritis, or chondrocalcinosis.
• Pre-operative pain in the knee should be minimal when the patient is at rest since pain at rest may indicate that there may be an inflammatory component to treat first.
• ACL tear injuries
• Osteochondral injuries with the following conditions:
• Involvement of more than 1/3 of the condylar surface
• When the OCD lesion is more than 5 mm deep, osteotomy alone may not be sufficient to restore adequate function to the knee (in these cases, allografting should be considered)

How do you prepare for the surgery?

A complete body examination and imaging tests assist the operating doctors in preparing an appropriate treatment plan.

Medical Evaluation

A thorough medical and physical evaluation should be done before any surgical procedure.

Medications

It is essential to inform the treating orthopaedic surgeon about any ongoing medications since some medicines need to be stopped or have their doses reduced before the surgery begins. Blood thinners need to be stopped three days before surgery and two days after to control bleeding during the procedure.

Other factors to be considered are

Smoking and drinking should be stopped for a week before surgery until wholly healed from surgery. Following a well-regulated exercise regime and a nutritionally balanced diet can help faster recovery. Research says that people who smoke are more susceptible to suffering complications from joint replacement surgery than non-smokers. About 12 hours of fasting is recommended before the surgical procedure to avoid anaesthetic complications.

Possible Complications

Osteotomy is a relatively safe procedure. However, every surgery carries its own risks and possible complications. Prior to the surgery, the doctor would discuss all the measures that need to be taken to avoid any complications that may occur before, during, and after the surgery. Although the risks are too low, the most common complications of osteotomy are:

• Infection or sepsis
• Formation of blood clots
• Stiffness of the involved joint
• Injuries to vessels and nerves
• Swelling that may take longer to resolve
• Unbearable pain
• Failure of the osteotomy site to heal

Sometimes, a second surgery may be necessary, particularly if the osteotomy does not heal.

Care after surgery

• Hospital discharge: In most cases, patients can return home within one or two days after the surgery.
• Pain management: After surgery, one must take pain medications as advised by the doctor. For instance, opioids, NSAIDs
• Weight-bearing: Using crutches after the surgery helps to walk easily and conveniently. A knee brace or cast may be placed to limit the movement of the operated bones.
• Regular follow-ups are essential to assess how well the bones have healed.
• Rehabilitation exercises: During rehabilitation, a physical therapist guides with the exercises to follow to help maintain the range of motion.

All activities can be resumed 3 to 6 months after surgery.

Review

Reviewed by Dr. Karan Baveja, Senior Consultant, Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury.