Osteotomy

Written by Dr Sheila Strover on March 14, 2025

Osteotomy is a surgical procedure where a bone is cut and realigned or repositioned to improve the forces going through the area.

Illustration of plate and screws positioned to maintain the new bone alignment.
Illustration of the bones at the side of the knee showing the opened wedge fixed by a plate.

In an osteotomy to re-align the knee, strong metal or carbon fibre plates and screws ("hardware") are used fix the bones in the new position, until new bone heals the defect, after which time the surgeon and patient may elect to remove the plate.

When is a knee osteotomy indicated?

Osteotomies may be performed when a poor alignment of the joint results in limb deformity or pain, or to decrease the forces going through a vulnerable area such as the meniscus in the knee.

This procedure is particularly indicated in the younger patient to delay knee replacement.

".......Osteotomy..."is an effective treatment for knee osteoarthritis and has unique advantages compared to knee arthroplasty."

Peng H et al

Cosmetic osteotomy may also be done to improve the cosmetic appearance of a limb or joint.

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Common osteotomy procedures in the knee

Common osteotomy procedures relating to the knee include -

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Planning software for osteotomy

Photograph of a computer screen showing the planning software
Planning software with full-length weight-bearing X-rays allows pre-operative calculation of the required amount of wedge correction in the tibia in mm.
X-ray image to check the new gap.
Laminar spreaders open the wedge of a high tibial osteotomy, and then the bone is held in the new position with a plate and screws until new bone fills the gap.

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Rehabilitation after osteotomy

Rehabilitation after osteotomy requires a balance between keeping the limb moving and the muscles strong, and avoiding damage to the hardware (plates and screws) until the bone reunites.

The patient will be keep non-weight-bearing on crutches for some weeks, and gradually start to bear weight.

Hydrotherapy allows exercise in a non-weight-bearing environment.

"...an aquatic rehabilitation protocol....demonstrated significant improvements in the evaluated parameters of pain and amplitude of the lower limbs...."

Santos S et al

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