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What is
Osteotomy?
Osteotomy, or bone cutting, is a method in
which a surgeon takes out a wedge of bone
near a injured joint. This transfers weight
from an area where there is damaged
cartilage
to an area where there is more or healthier
cartilage.
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Effects
of Osteotomy
Osteotomy provides permanent pain relief and
delays the development of osteoarthritis.
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Candidates
for Osteotomy
This procedure is ideal for those who have
x-rays showing involvement of only one side
of the knee joint, significant pain and
disability, as well as the ability to
cooperate with physical therapy and
rehabilitation.
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Your
Consultation
The patient will have to go through physical
examination and give the doctor a complete
medical history. When rehabilitation or
other treatments are ruled out and surgery
is necessary, the doctor must evaluate for
three factors: pain, instability and knee
alignment. Osteotomy is proposed if
misalignment is a factor. It must be
ascertained whether the instability is
connected to misalignment and not to other
sources like ACL injury.
A
diagnostic arthroscopy, examination of the knee joint with a
long tube connected to a video camera, is normally done
before all knee osteotomies. The cartilage surfaces are
examined for degenerative or late-stage arthritis. Also, magnetic
resonance imaging (MRI) is helpful in evaluating any intra-articular
pathology such as bone chips, padding tears or injuries to
ligaments.
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The Osteotomy
Procedure
In an osteotomy, the surgeon cuts the bone
and then reorients it. There are two basic
types of osteotomies: closing wedge, where a
wedge of bone is taken out to modify the
alignment of the bone; and opening wedge,
where bone is gapped open on one side to
realign the bone. The surgeon will select
which treatment to perform, depending on the
kind of deformity and the site of your
osteotomy. As soon as the bone is cut and
then realigned, your surgeon may opt to use
metal plate and screws to hold the bones in
the new position.
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Recovery
Recovery depends on the surgical technique
plus the strength and motivation of the
patient. A cast or splint may reduce
movement of the joint for 4 to 8 weeks. You
will begin physical therapy instantly, 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
subsequent to the surgery. It may take up to
a year for the knee to completely adjust to
its fixed position.
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Risks
Risks
associated to osteotomy include failure of
the bones to heal or failure to heal
appropriately, blood clotting, bleeding in
the joint, inflammation of joint tissues,
nerve damage, or infection.
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Frequently Asked
Questions
Q:
What
is
the
purpose
of
an
osteotomy?
A:
Doctors opt for osteotomy if destruction of the knee
cartilage largely affects a single disc of
cartilage: the disc (meniscus) either on the inner part or
on the outer part of the knee joint.
Osteotomy is a suitable treatment for younger, active people
with osteoarthritis who can delay a total joint replacement.
Q: How
effective is osteotomy?
A:
If the amount of correction required to align the knee is
somewhat small, osteotomy is effective in stabilizing the
knee and alleviating pain symptoms in approximately 90% of
cases.
Q:
Who is
not a good candidate for a knee osteotomy?
A:
As
a rule, patients should not consider this surgery if they
have:
-
Prevalent arthritis of the knee (not confined to one
side)
-
Unsteadiness of the knee or tibial subluxation
-
Substantial limitations of knee motion
-
Such
a noteworthy deformity, it would be hard to correct
-
Inflammatory arthritis (such as rheumatoid arthritis)
Q: Are there complications in this procedure?
A:
Although complications are odd, there is a minor probability
of infection or blood clots. There is also a very low stake
of the bone not healing accurately, a nerve or artery being
cut at some point in the surgery, or poor skin healing.
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