Osteotomy: Bone correction in orthopaedics, trauma surgery and general surgery – with a focus on the knee joint and osteosynthesis

An osteotomy is a surgical procedure in which a bone is deliberately cut. The aim is to correct misalignments, relieve pain and improve or restore the function of joints, such as the knee joint. This surgical procedure is an important part of modern orthopaedics and trauma surgery. This article explains what an osteotomy is, when it is used and what patients need to know about it – including important considerations regarding financial cover.

What is an osteotomy? (Definition)

The term „osteotomy“ is derived from Greek and literally means ‘bone cut’ (osteon = bone, tome = cut). It is a surgical procedure in which a surgeon deliberately cuts through one or more bones. This may be necessary to alter the axis of a bone, to lengthen or shorten a bone, to correct a misalignment, or to optimise the load-bearing conditions in a joint. The bone fragments are usually stabilised in their new position by means of osteosynthesis. Osteosynthesis refers to the surgical fixation of bone fragments.

Objectives of an osteotomy

• Pain relief: Particularly in the case of osteoarthritis (joint wear and tear), by relieving pressure on the damaged parts of the joint.
• Correction of malocclusions: Congenital or acquired deformities (e.g. bow legs/genu varum, knock-knees/genu valgum) of the leg axes can be corrected.
• Functional improvements: Restoring or improving the mobility and stability of a joint.
• Slowing the progression of the disease: In cases of osteoarthritis, an osteotomy can slow down the progression of the condition, thereby avoiding the need for joint replacement in many cases, or at least postponing it.
• Cosmetic corrections: Particularly in the jaw area, to improve the bite and facial profile.

When is an osteotomy advisable? (Indications)

An osteotomy may be considered when conservative orthopaedic treatments (such as physiotherapy, medication and orthopaedic aids) no longer provide sufficient relief. Typical indications include:

• Osteoarthritis (joint degeneration), particularly in the early to moderate stages in younger, active patients.
• Limb alignment abnormalities (e.g. genu varum/bow legs, genu valgum/knock-knees).
• Hip dysplasia (abnormal development of the hip socket).
• Consequences of bone fractures (fractures) involving malunion and resulting in bone deformities.
• Growth disorders.
• Certain foot deformities (e.g. hallux valgus at the metatarsophalangeal joint of the big toe, bunion).
• Malocclusions and bite abnormalities.

Common indications for osteotomies

• Knee joint: Often performed as a realignment osteotomy (e.g. high tibial osteotomy, HTO) in cases of unilateral knee osteoarthritis or axial malalignment of the tibia. The aim is to alter the line of load along the leg axis so that the healthier part of the joint bears more weight, relieving the damaged area with worn cartilage and thereby also protecting the meniscus. This is a standard procedure for bow legs.
• Hip joint: In cases of hip dysplasia or certain forms of hip osteoarthritis, a pelvic osteotomy (e.g. a triple osteotomy of the pelvic bone) or a femoral osteotomy can improve the function of the hip socket and the entire joint surface. The hip socket is often repositioned during the procedure.
• Pine: Orthodontic surgery (orthognathic surgery) uses osteotomies to correct misalignments of the upper or lower jaw, improve the bite and harmonise the facial profile.
• Other areas: Osteotomies are also performed on the foot (e.g. to correct hallux valgus, a valgus deformity of the big toe or bunion, often involving the first metatarsal bone), on the shoulder, on the elbow, on the talus or other ankle joints. A corrective osteotomy may also be necessary on the inner ankle.

The procedure for an osteotomy operation

The exact procedure varies depending on the type and location of the osteotomy. The orthopaedic surgeon or surgeon in charge plans the operation in detail. In general, the process involves the following steps:

1. Preparation and planning Accurate diagnosis using X-rays, and often CT or MRI scans, to precisely assess the misalignment. Precise planning of the incision and the extent of the correction, frequently with the aid of computer-assisted techniques. A consultation to explain the procedure, the risks and the post-operative recovery process.
2. The surgical procedure The operation is usually carried out under general or regional anaesthesia. The surgeon exposes the bone to be operated on via an incision in the skin. The bone is cut precisely using special instruments (saws, chisels). Depending on the objective, either a wedge of bone is removed (closing-wedge osteotomy) or a gap is created and a wedge (possibly with bone graft material) is inserted (opening-wedge osteotomy).
3. Bone fixation (osteosynthesis) Following realignment, the severed bone segments or bone fragments are stabilised. This osteosynthesis is usually carried out using plates and screws (plate osteosynthesis), wires (wire cerclage) or special pins to fix the bones in the desired position. In rare cases, an external fixator is also used.

After osteotomy: Recovery and rehabilitation

The osteotomy is followed by a healing phase, the duration of which varies from person to person and depends on the bone being operated on, the extent of the procedure and patient-specific factors such as the presence of osteoporosis. It usually lasts from several weeks to several months.

• Hospital stay: A few days to a week.
• Partial weight-bearing/rest: It is often necessary to apply partial weight-bearing or to rest the operated area completely for a few weeks.
• Physiotherapy: An important part of rehabilitation aimed at restoring mobility, strength and coordination, and also at reducing swelling or inflammation.
• Removal of osteosynthesis hardware: Sometimes the plates and screws need to be removed in a further, minor operation once the bone has fully healed.

Benefits of an osteotomy

• Preservation of the patient’s own joint.
• Pain relief and improved function; normalisation of physical activity.
• Delaying or avoiding the need for joint replacement surgery.
• Correction of deformities and abnormal weight-bearing.
• It is often possible to take part in sporting activities again.

Potential risks and complications of the surgical procedure

Like any surgical procedure, an osteotomy also carries risks:

• General surgical risks (infections, impaired wound healing, thrombosis, embolism, inflammation, swelling).
• Injury to nerves or blood vessels.
• Delayed bone healing or failure to heal (pseudoarthrosis).
• Bone misalignments caused by sub-optimal correction (over-correction or under-correction).
• Material failure, loosening or a new fracture in the material or bone.
• Persistent pain.
• The need for follow-up surgery (including, where necessary, a repeat corrective osteotomy).

Questions and answers about osteotomy