Osteotomy ("bone cutting") is a procedure in
which a surgeon removes, or sometimes adds, a wedge of bone near a damaged joint. This shifts
weight from an area where there is damaged
cartilage to an area where there is more or healthier
osteoarthritis, cartilage breakdown in the knee often
is much greater in the inner part of the knee joint, often resulting in a
bowlegged appearance. Surgery to shift the weight away from the inner knee is one of the most common uses of osteotomy for osteoarthritis. The idea is to tilt your body weight toward the outer,
healthier part of the knee cartilage and away from the inner, damaged
cartilage. Weight is then spread more evenly across the joint cartilage. The surgery may be done in one of several ways. It may be done on the thighbone (femur) or the large lower leg bone (tibia).
The most common way to use osteotomy for osteoarthritis of the inner knee is to remove a wedge of bone from the outer side of the large lower leg bone (tibia) near the knee. After removing the bone wedge, your surgeon will bring together the remaining bones
and secure them, most often with either pins or staples.
Osteotomy for osteoarthritis of the inner knee could also include adding a wedge of bone to the inner tibia, or adding or removing bone from the femur. Osteoarthritis of the outer knee is treated in just the opposite way. For example, your surgeon may remove bone from the inner side of the lower leg to shift the weight toward the inner knee.
Osteotomy may be effective for hip and knee joints. Doctors
often do an osteotomy to correct certain knee deformities such as bowleg
(varus) and knock-knee (valgus) deformities of the knees. Hip osteotomy
involves removing bone from the upper thighbone (femur). Osteotomy may allow an
active person to postpone a total joint replacement for a few years and is
usually reserved for younger people.
What To Expect After Surgery
Recovery depends on the surgical
technique as well as the strength and motivation of the person having surgery.
A cast or splint may limit movement of the joint for 4 to 8 weeks.
You will start physical therapy immediately, even if you are in a cast or
splint. When the cast is removed, you can put your full weight on the joint 10
to 12 weeks after the surgery. It may take up to a year for the knee to fully
adjust to its corrected position.
Why It Is Done
Doctors use osteotomy if destruction
of the knee
cartilage mainly affects a single disc of cartilage:
the disc (meniscus) either on the inner part or on the outer part of the knee
Osteotomy is an appropriate treatment for younger, active
people with osteoarthritis who are able to delay a total joint
How Well It Works
Osteotomy is most often done in
younger people. It can help relieve pain and delay the need for joint
A failure of the bones to heal
Bones that don't align as they heal
Bleeding in the
Inflammation of joint tissues, nerve damage, or
What To Think About
By shifting the weight onto good
cartilage, osteotomy may "buy time" for younger or more active people before
they need a total joint replacement.
Lozada CJ (2013). Treatment of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology 9th ed., vol. 2, pp. 1646–1659. Philadelphia: Saunders.
ByHealthwise Staff Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine Adam Husney, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Specialist Medical ReviewerKenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine
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