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Realignment Osteotomy

General Orthopedic

What is Realignment Osteotomy?

A realignment osteotomy is a surgical procedure in which one or more bones are cut and reshaped to restore normal alignment. There are various types of osteotomies, which are employed to treat several orthopedic injuries and conditions. Usually, an osteotomy involves the realignment or removal of a section of bone to correct an issue that affects an individual’s growth and movement. You may need a realignment osteotomy to repair a damaged joint or to lengthen or shorten a deformed bone that is not lining up properly like it should with a joint.

Realignment osteotomy helps to:

  • Rectify poor joint alignment
  • Prolong joint life
  • Shift weight from the arthritic area of the joint to a healthier part

Types of Realignment Osteotomy

There are several types of realignment osteotomy, including:

  • Knee osteotomy
  • Femoral osteotomy
  • Ankle osteotomy
  • Spine osteotomy
  • Pelvic osteotomy
  • Distal radius osteotomy
  • Tibial derotational osteotomy

Knee osteotomy is the most common form of realignment osteotomy. It is a surgical procedure in which the upper part of shinbone (tibia) or lower part of thighbone (femur) is cut and realigned. It is usually performed in arthritic conditions affecting only one side of your knee. The aim is to take pressure off the damaged area and shift it to the other side of your knee with healthy cartilage. During the surgery, your surgeon will remove or add a wedge of bone either below or above the knee joint, depending on the site of arthritic damage.

Indications for Realignment Osteotomies

Normally, individuals who are under the age of 60, overweight, and active are considered as suitable candidates for realignment osteotomy. It is mostly done to:

  • Alleviate arthritic pain, especially of the knee and hip
  • Enable shortening or elongation of a bone in conditions such as leg length discrepancy
  • Rectify malalignment of a joint as a result of malunion
  • Correct congenital/developmental deformities such as genu varum, genu valgum, and coxa vara
  • Rectify excessive bowing, rotation, or angulation of long bones

Preparation for Realignment Osteotomy

Preoperative preparation for realignment osteotomy will involve the following steps:

  • A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anaesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least a week prior to surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Realignment Osteotomy

The most commonly employed realignment osteotomy technique is the closed wedged osteotomy. The procedure involves the following steps:

  • Regional or general anaesthesia is administered and the surgical area is sterilized with an antibacterial solution.
  • Your surgeon will map out the exact size of the bone wedge to be removed, using an X-ray, CT scan, or 3D computer modelling.
  • Your surgeon makes an incision in front of the joint and removes a small wedge of bone near the damaged joint.
  • Your surgeon brings the remaining bones together and secures them using staples or pins.
  • Internal plates or an immobilization cast may also be utilised for additional stability.
  • The procedure unloads the pressure off the damaged joint area and helps to transfer some of the weight to the outer part of the joint, where the cartilage is still intact and ensure even distribution of weight across the joint cartilage.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after realignment osteotomy will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
  • You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
  • Antibiotics may be prescribed to address the risk of surgery-related infection.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • Refrain from smoking as it can negatively affect the healing process.
  • Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
  • Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
  • An individualised physical therapy protocol will be designed to help strengthen your joint muscles and optimise joint function.
  • You will be able to resume your normal activities, as well as drive in 3 to 4 weeks after surgery; however, return to sports may take at least a year or longer.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Realignment osteotomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following: 

  • Infection
  • Skin necrosis
  • Hemarthrosis (bleeding inside a joint)
  • Nerve and blood vessel injury
  • Non-union (failure of the bones to heal)
  • Deep vein thrombosis or blood clots
  • Failure to correct the deformity
  • Anaesthetic/allergic reactions