What is an osteotomy?

An osteotomy is a surgical procedure that consists of straightening the affected lower extremity, so that the distribution of loads in the knee has a homogeneous distribution or in case of any of the deteriorated compartments, decrease the load that the surface supports. The operation consists of making a cut in the tibia or femur according to the type of deformity that exists, get a correct load axis and fix the correction with a plate and screws that once consolidated can be removed.

In some types of osteotomy it is necessary to use bone grafts that are obtained from the patient's own iliac crest or from a tissue bank. It is an intervention that offers good results without the need to replace living tissue, such as our bone, by an artificial material subjected to wear and tear, such as the knee prosthesis.

In addition to being the gold standard in the treatment of unicompartmental osteoarthritis associated with genu varus or valgus in relatively young adult. However, it is an intervention performed by very few orthopedic surgeons in our country and this is because it is a very demanding surgery for the surgeon. This demand is found in two difficulties: 

• The correct choice of technique: as we have said there are different ways to perform it and to decide the correct is necessary to have a very accurate knowledge of where the problem is and therefore customize the surgery for each patient 
• To achieve an alignment as accurate as possible: in addition to the experience of the surgeon, it is advisable to use special instrumentation such as intraoperative navigation with infrared or preoperative navigation based on the design of customized guides with 3D reconstruction from CT or Magnetic Resonance Imaging. Both techniques allow us to discriminate a millimeter and a degree, something very difficult to achieve with our vision. 

Finally, the osteotomy should be accompanied by an arthroscopic review of the joint to check the condition of the region to which the load is to be transmitted, as well as to resolve possible meniscal or chondral injuries that may exist.

How is the process of an osteotomy? When is it advised?

The procedure is usually performed in the same operation , although sometimes it has to be done on both legs and in this case it is recommended not to do the next until the consolidation of the first. On the other hand, once the osteotomy has consolidated, a second intervention can be performed to remove the material. This second intervention is very simple and the recovery does not last another week, specifically until the withdrawal of points.

Knee osteotomy is a procedure that is performed when there is deterioration of one of the knee compartments and there is also a poor alignment of the affected leg. But also, on other occasions, the osteotomy is used to protect other operations, either cross-ligaments, cartilage lesions, and meniscal sutures or transplants in patients who have poor alignment of the lower limb

Is osteotomy a good alternative to knee prostheses? What are the advantages?

The advantage of the osteotomy is that we keep our bone, which is a living tissue, and can reincorporate us into our sporting or recreational activity. But it must be taken into account that in many cases it is a transient procedure with which it is possible to delay the placement of a prosthesis for a few years, in order to avoid the wear that during this time could suffer the prosthesis. This is very important because the prostheses are subject to wear and this causes them to loosen and need to be removed and place a new one, the result will not be better than the first.

What is the recovery of an osteotomy?

The recovery is similar to that of a fracture and will depend on the type of osteotomy performed, the degree of correction of the bone and the quality of the bone. But generally it is usually twelve weeks. During this time the patient will walk with two crutches and partial load the first four or six, according to the type and other four with a crutch. The goal of the osteotomy is that the patient does not have pain and can return to perform the same sports, work or recreation that he did before the intervention, but with an alignment of the extremity affects more physiological

For more information consult a specialist in Traumatology .