Osteotomy

What this procedure is

An osteotomy is a surgical procedure where a surgeon carefully cuts and reshapes a bone. The word literally means "cutting of the bone." The main goal is usually to change the alignment of a joint or to shift weight away from a damaged area to a healthier one.

During the surgery, your clinician may remove a small wedge of bone or add a piece of bone to change the angle of the joint. Once the bone is moved into the correct position, it is typically held in place with metal plates or screws. This allows the bone to heal and grow back together in its new, improved shape.

What it treats or fixes

This procedure is most often used to treat osteoarthritis, which is a condition where the protective cushion (cartilage) in a joint wears down over time. It is especially helpful when the damage is only on one side of the joint. By realigning the bone, the surgery shifts pressure to the side of the joint that still has healthy cartilage.

Your clinician may recommend an osteotomy to help with:

• Correcting bone alignment, such as being "bow-legged" or "knock-kneed."
• Reducing pain and improving function in the knee, hip, or spine.
• Delaying the need for a total joint replacement surgery by preserving your natural joint.
• Fixing a bone that did not heal straight after a previous break or injury.

How common it is & where it's done

Osteotomy is a well-established orthopedic procedure. While total joint replacements are very common, osteotomies are a frequent choice for younger or more active patients who want to keep their natural joint for as long as possible. It is a standard option for treating specific types of knee and hip issues.

The procedure is typically performed in a hospital or a specialized surgical center. Because it involves reshaping the bone, it is done under anesthesia so you will not feel anything during the surgery. Most patients stay in the hospital for a short time afterward so the medical team can monitor their initial recovery and help them begin moving safely with crutches or a brace.

Recovery: What to Expect

Healing from an osteotomy—a surgery where a bone is cut and reshaped—takes time and patience. Your clinician may ask you to use crutches, a walker, or a brace for several weeks. This helps protect the bone while it heals and knits back together in its new position.

Physical therapy is a very important part of your journey. You will work with a therapist to learn gentle exercises that improve your strength and help you move more easily. Most people find that their ability to move improves gradually over several months.

Risks & Possible Complications

While most people do well, every surgery has some risks. These can include infection, blood clots, or the bone taking longer than expected to heal (called a non-union). Your surgical team takes many steps to prevent these issues.

It is helpful to know when to reach out for extra help. You should contact your clinician if you notice:

• Increased redness, warmth, or swelling around the surgical site.
• A fever or chills.
• New or worsening pain that does not get better with rest or medicine.
• Sudden swelling or pain in your calf or leg.

Outcomes & Long-Term Results

The main goal of an osteotomy is to shift weight away from a damaged part of a joint and onto healthier bone. This can significantly reduce pain and make it easier to perform daily activities. For many patients, this procedure can delay the need for a total joint replacement for many years.

Long-term success often depends on following your recovery plan. Your clinician will help you understand what level of activity is best for your specific situation to keep your joints healthy for as long as possible.

Emotional Support & Reassurance

It is completely normal to feel a bit anxious before a surgical procedure. Remember that an osteotomy is a common and effective way to help people stay active and reduce pain. Your healthcare team is dedicated to your comfort and safety throughout the process.

Focusing on small goals each day during recovery can help you stay positive. With time and the right support, most patients feel more confident and comfortable in their movements.

Why doctors recommend it

An osteotomy is a surgical procedure where a bone is cut and reshaped to change its alignment. Your clinician may recommend this if you have joint damage, such as osteoarthritis, that affects only one side of your knee. By changing the angle of the bone, the surgeon can shift your body weight away from the damaged area and onto healthy cartilage (the slippery tissue that cushions the ends of bones).

This procedure is often suggested for younger, active patients who want to maintain a high level of physical activity. It is also used to correct malalignment, such as being bow-legged or knock-kneed. Correcting these angles helps prevent the joint from wearing out unevenly over time.

Urgent vs planned treatment

An osteotomy is almost always a planned, elective procedure. This means it is not an emergency, and you can work with your care team to decide on the best timing. Your clinician may suggest this surgery after you have tried other options, such as:

• Physical therapy to strengthen the muscles around the joint.
• Using a specialized brace to support the limb.
• Managing weight to reduce pressure on the bones.

If these non-surgical treatments no longer manage your pain or if the joint damage is getting worse, a planned surgery may be scheduled to help protect the joint's long-term health.

Goals of treatment

The primary goal of an osteotomy is to reduce pain and improve your ability to move. By redistributing the pressure within the joint, the surgery aims to slow down the wear and tear caused by arthritis. This can help you stay active and perform daily tasks with less discomfort.

Another important goal is to delay the need for a total joint replacement. For many people, a successful osteotomy can provide many years of relief before a more complex surgery is necessary. Success is often measured by how well you can return to your favorite activities and how much the surgery improves your overall quality of life.

Who may benefit

An osteotomy is a surgical procedure where a bone is cut and reshaped. Your clinician may suggest this if you have damage in only one part of a joint, such as the knee. By changing the angle of the bone, the surgeon can shift your body weight away from the worn-out area and onto healthier cartilage, which is the smooth tissue that cushions your joints.

This procedure is often considered for younger, active people who want to stay physically busy. It is frequently used to correct alignment issues, such as being bow-legged or knock-kneed. By realigning the joint, the surgery may help reduce pain and slow down further wear and tear. This can help preserve your natural joint and potentially delay the need for a full joint replacement for several years.

When it may not be the right option

While helpful for many, an osteotomy may not be the best choice if arthritis has already spread to multiple parts of the joint. If the joint is very stiff or has a limited range of motion before surgery, reshaping the bone might not provide the relief you need. Your clinician will likely check to see if your joint is stable and if you can still move it well before recommending this path.

Your care team may also look at other health factors. For instance, inflammatory conditions like rheumatoid arthritis usually affect the entire joint, making a localized bone reshaping less effective. Other factors, such as smoking or certain health conditions that affect how bones heal, might lead your clinician to suggest different treatment options to ensure the best outcome for your health.

Questions to ask your care team

Deciding on surgery is a big step. You may want to bring a list of questions to your next appointment to help you understand if this is the right choice for your lifestyle. Consider asking:

• How will this surgery help delay the need for a total joint replacement?
• What specific part of my joint is damaged, and how will realigning the bone help?
• What are the goals for my activity level after I fully recover?
• How long is the typical recovery period before I can put full weight on my leg again?
• Are there specific lifestyle changes I should make to help my bone heal better after the procedure?

In the procedure room

When you enter the room, you will see the surgical team and various medical monitors. The staff will help you get comfortable on the procedure table. The area of your body being treated will be cleaned with a special soap to prevent infection, and sterile cloths will be placed around it to keep the area clean.

High-level steps

An osteotomy is a procedure where a bone is reshaped or realigned. Your clinician may make a small cut in the skin to reach the bone. They then carefully cut the bone to remove a small wedge or to shift its position. This is often done to take pressure off a damaged joint, like the knee, and move it to a healthier area.

To keep the bone in its new position, the surgeon may use metal plates, screws, or pins. These help the bone stay stable while it heals over the coming months. This process helps the bone grow back together in its new, improved alignment.

Anesthesia and pain control

To ensure you are comfortable, you will receive anesthesia. This may be general anesthesia, which puts you into a deep sleep, or regional anesthesia, which numbs a specific part of your body. If you have regional anesthesia, you may also receive medicine to help you feel relaxed or sleepy.

You should not feel pain during the procedure, though you might feel some pressure or a sense of movement. Your care team will monitor your comfort levels throughout the entire process to ensure you remain relaxed.

Monitoring and safety steps

Your safety is the top priority. The team will use monitors to track your heart rate, breathing, and blood pressure the entire time. They also use imaging, like X-rays, during the surgery to make sure the bone is moved to the exact right spot.

Before the surgery begins, the team performs a "time-out." This is a standard safety check where everyone stops to double-check your information and the surgical plan. This ensures the correct procedure is performed on the correct part of the body.

Immediately after the procedure

After the surgery is finished, you will be moved to a recovery area. Nurses will watch you closely as you wake up from the anesthesia. You may feel some soreness, grogginess, or numbness in the area that was treated as the medicine begins to wear off.

Your clinician may place a brace or a cast on the limb to keep it still and protected while the bone starts to heal. They will also talk to you about how to manage any discomfort and when it is safe to begin moving the joint again.

Typical procedure length

Most osteotomy procedures take about 1 to 2 hours. The exact time depends on which bone is being treated and the specific technique your clinician uses. Your surgical team can give you a more specific estimate based on your individual needs.

Common approaches (open vs minimally invasive)

Surgeons use different techniques to cut and realign the bone depending on the type of correction needed. Two standard methods are the opening wedge and closing wedge osteotomy. In an opening wedge procedure, the doctor makes a cut and opens a gap in the bone, often filling it with a bone graft to hold the new position. In a closing wedge procedure, a wedge-shaped piece of bone is removed to change the angle.

While many osteotomies are open surgeries to allow full access to the bone, some techniques are designed to be less disruptive to the surrounding tissue. For example, a corticotomy involves cutting the outer shell of the bone while preserving the blood supply and marrow inside. Your clinician will choose the approach that offers the best stability for your specific injury or deformity.

Partial vs total

Osteotomy is often described as a joint-preserving surgery. It is frequently chosen for patients who have damage in only one part of the joint, such as "unicompartmental" osteoarthritis (arthritis affecting only one side of the knee). The goal is to shift weight away from the damaged area toward healthy bone and cartilage.

This differs from a total joint replacement (arthroplasty), where the entire joint is removed and replaced with artificial parts. Doctors often recommend osteotomy for younger, active patients to delay the need for a full replacement. However, this option is not always applicable; if arthritis affects the whole joint, a total replacement may be the better choice.

Revision or repeat procedures

For many patients, an osteotomy is considered a "temporizing" procedure. This means it is intended to buy time and delay the need for major surgery, such as a total knee replacement, often for many years. Eventually, as natural wear and tear continues, a total joint replacement may still be required later in life.

In some cases, a revision surgery is needed sooner if complications occur. For instance, if the cut bone fails to heal together (nonunion) or if the deformity returns, the surgeon may need to perform another procedure to stabilize the bone or correct the alignment again.

Tests and imaging that may be done

Before an osteotomy, your healthcare team needs a detailed map of your bones and joints. This planning phase is essential to ensure the bone is cut and realigned correctly. Your clinician will likely order specific imaging tests to evaluate the deformity and the health of the joint.

• X-rays: These are standard for looking at bone structure and measuring alignment.
• CT scans or MRI: These may be used to see the joint surface and soft tissues, such as ligaments, in greater detail.
• Blood tests: Laboratory work is often done to check your overall health based on your medical history.

You may also need to visit your primary care doctor for a general check-up. This is often called "medical clearance" to confirm you are healthy enough for surgery.

Medication adjustments

Your surgeon will review your current medications, vitamins, and supplements. Certain drugs can affect how your blood clots or how your bones heal. It is important to have a plan in place for managing these medicines safely.

• Blood thinners: If you take anticoagulants (blood thinners), your team will discuss how to manage them before and after surgery to prevent excess bleeding.
• Nicotine products: Smoking can slow down bone healing and increase the risk of complications. Your clinician will strongly encourage you to stop smoking before the procedure.

Note: Only stop medicines if your clinician instructs you to do so. Always follow their specific schedule for pausing or continuing your prescriptions.

Day-before and day-of instructions

Because osteotomy involves anesthesia (either general anesthesia or a regional block), you must follow strict safety rules on the day of your surgery.

• Fasting: You will likely be instructed not to eat or drink anything after a certain time the night before surgery. This helps prevent complications while you are under anesthesia.
• Hygiene: You may be asked to shower with a special antibacterial soap to lower the risk of infection.
• What to wear: Dress in loose, comfortable clothing that is easy to remove.
• Logistics: Arrive at the surgery center or hospital at the time assigned to you. Be sure to bring your identification and insurance information.

General surgical risks

Like any operation, an osteotomy comes with certain risks. Your surgical team takes many precautions to keep you safe, but it is important to understand the potential side effects. General risks associated with surgery include:

• Infection: Bacteria can sometimes get into the incision site or deeper around the bone.
• Blood clots: Clots may form in the leg veins (deep vein thrombosis) and can be serious if they travel to the lungs.
• Nerve or blood vessel injury: Nerves and vessels near the surgical area can be stretched or injured during the procedure.
• Anesthesia reactions: Some patients may experience nausea or other reactions to the medication used during surgery.

Procedure-specific complications

Because osteotomy involves cutting and realigning bone, there are specific complications related to how the bone heals. While these are not common for everyone, your doctor will monitor your recovery closely to check for them.

• Bone healing issues: The cut bone may take longer than expected to heal (delayed union) or may fail to knit back together completely (nonunion). In some cases, the bone may heal in a position that is not perfectly aligned (malunion).
• Hardware problems: The metal plates, screws, or rods used to hold the bone in place can sometimes break, loosen, or irritate the nearby soft tissues.
• Compartment syndrome: This is a condition where pressure builds up within the muscles, potentially blocking blood flow. It is rare but requires immediate medical attention.
• Recurrence: Over time, there is a chance that the deformity or alignment issue could return.

How complications are treated

Most complications can be managed successfully, especially when they are detected early. Your clinician will provide specific instructions on what signs to watch for at home.

• Infections: Mild infections are usually treated with antibiotics. If an infection is deep, a procedure to clean the wound may be necessary.
• Blood clots: Doctors often prescribe blood-thinning medication or compression stockings to help prevent or treat clots.
• Healing issues: If the bone is not healing well, your doctor might suggest using a bone stimulator device or performing a revision surgery to help the bone join.
• Hardware pain: If the metal implants cause pain or irritation after the bone has fully healed, they can often be removed with a follow-up procedure.

Pain control medicines

Managing discomfort is a key part of recovery after an osteotomy (a surgery where a bone is cut and reshaped). Your clinician may use a combination of different medicines to help you feel comfortable. This often includes NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen or naproxen, which help reduce both pain and swelling.

For stronger pain in the first few days, your clinician may prescribe opioids. These are used for a short time to manage severe pain that other medicines cannot handle. You might also take acetaminophen to help the other medicines work more effectively.

Your care team will tailor your plan based on your health history. It is important to tell them about any allergies or other medicines you take, as some pain relievers can interact with other drugs or affect your stomach and kidneys.

Antibiotics

To help prevent an infection at the surgical site, your clinician may give you antibiotics. These are medicines that kill or stop the growth of harmful bacteria. Most patients receive a dose through an IV (a small tube in the vein) just before the surgery begins to ensure the medicine is in your system during the procedure.

In some cases, you might continue taking antibiotic pills for a short time after you go home. Your clinician will choose the specific type based on your needs and any known allergies, such as a sensitivity to penicillin or similar medications.

Blood thinners and clot prevention

After bone surgery, there is a risk of developing a blood clot, also known as deep vein thrombosis (DVT). To lower this risk, your clinician may prescribe blood thinners, or anticoagulants. These medicines help keep your blood flowing smoothly while you are less active during the early stages of recovery.

Common options include low-dose aspirin, pill-form thinners, or small injections under the skin. Your clinician will decide which one is right for you and how long you need to take it. They will also monitor you for any signs of unusual bruising or bleeding, which are important safety considerations when using these medicines.

Emergency warning signs

While recovering from an osteotomy, certain symptoms require immediate attention. You should go to the emergency room or call emergency services if you experience signs of a blood clot in the lungs or severe pressure within the muscles (compartment syndrome).

Seek emergency care if you have:

• Sudden chest pain or trouble breathing.
• Severe pain that does not get better with pain medicine.
• A leg that feels hard, tight, or tense.
• A foot that turns pale, feels cold to the touch, or has no pulse.

Call your surgeon or clinic if…

Some symptoms may not be life-threatening but still need to be checked by your surgical team to prevent complications like infection or nerve issues. Contact your surgeon if you notice changes in how your leg looks or feels.

Reach out to your healthcare provider if you notice:

• Signs of infection: This may include a fever, chills, or redness spreading around the incision site.
• Drainage: New or bad-smelling fluid leaking from the wound.
• Nerve changes: Numbness, tingling, or an inability to lift your foot (foot drop).
• New calf pain: Pain or tenderness in the back of your lower leg, which could be a sign of a blood clot.

Expected vs concerning symptoms

It is normal to have some discomfort after bone surgery. Most people experience pain and swelling that gradually improves as the bone heals. Your care team will likely provide a plan to manage this with medicine, rest, and keeping the leg raised.

However, symptoms should not get worse over time. It is concerning if:

• Pain increases suddenly instead of getting better.
• Swelling stays severe even after elevating the leg and using ice as directed.
• The wound opens up or does not appear to be healing.

Non-surgical treatments

Before suggesting an osteotomy—a surgery where a bone is cut and reshaped to change its alignment—your clinician may recommend several non-surgical steps. These treatments aim to reduce pain and improve how the joint works without an operation. Common options include physical therapy to strengthen the muscles around the joint and weight management to reduce the pressure on your bones.

Your clinician may also suggest using an "unloader brace." This is a special support worn on the limb that helps shift weight away from the damaged area of the joint. Other options include medications to manage swelling or injections into the joint to help with discomfort.

Watchful waiting

Watchful waiting means you and your clinician monitor your symptoms over time without starting a new major treatment. This is often used when your pain is mild or only happens during specific activities. During this time, you might change your routine, such as choosing low-impact exercises like swimming instead of high-impact activities like running.

This approach allows you to see if the joint issues stay the same or get worse. It is a common first step for active patients who want to manage their symptoms while delaying surgery for as long as possible.

When surgery becomes the best option

Surgery may be considered when non-surgical treatments no longer provide enough relief. If pain starts to interfere with your daily life, such as making it hard to walk or perform your job, your clinician may discuss an osteotomy. This procedure is typically used for patients who have damage on only one side of a joint.

The main goal of an osteotomy is to shift your body weight onto healthier bone and cartilage—the protective tissue at the ends of bones. By doing this, the surgery can help delay the need for a total joint replacement for several years. It is often a preferred choice for younger, active people who wish to remain physically busy without the restrictions of a prosthetic joint.

Hospital services that commonly perform this surgery

An osteotomy is a surgical procedure where a bone is cut to shorten it, lengthen it, or change its alignment. This surgery is most often performed in the orthopedic surgery department of a hospital or a specialized surgical center. These departments focus on the health of your bones, joints, and muscles.

Because an osteotomy is often used to treat joint issues like arthritis or bone deformities, you may also work with specialized units. These can include sports medicine clinics or joint reconstruction centers. Your clinician may coordinate with these departments to ensure the bone is reshaped in a way that reduces pressure on your joints and improves your movement.

Patient resources and support services

Hospitals often provide resources to help you prepare for surgery and manage your recovery. Many facilities offer pre-operative education, which may include videos or classes that explain how to prepare your home and what to expect during your hospital stay. This helps reduce anxiety and ensures you have the right support in place before the procedure.

Common support services include:

• Physical Therapy (PT): Therapists who guide you through exercises to regain strength and mobility as the bone heals.
• Pain Management Services: Specialists who help manage discomfort using various methods during your recovery.
• Occupational Therapy (OT): Professionals who teach you how to perform daily tasks safely while your movement is restricted.
• Case Management: Staff who help arrange for home health care or medical equipment, such as crutches or braces, after you leave the hospital.

Questions for choosing where to have surgery

Choosing the right facility is an important step in your care. You may want to look for a hospital that has extensive experience with the specific type of osteotomy you need. Here is a checklist of questions to help you choose a facility:

• How many osteotomy procedures of this type does the surgical team perform each year?
• Does the facility have a dedicated orthopedic unit for recovery?
• Is physical therapy available on-site to help me start moving shortly after surgery?
• What resources are available for pain management after I am discharged?
• Does the hospital provide clear instructions and support for my recovery at home?

Conditions commonly treated by this procedure

An osteotomy is a surgery where a clinician cuts or reshapes a bone to change its alignment. This procedure is often used to treat osteoarthritis, a condition where the protective tissue (cartilage) in a joint wears down over time. It is most common when the wear and tear is limited to just one side of the joint, such as the inner part of the knee.

Other conditions your clinician may consider an osteotomy for include:

• Genu varum: This is the medical term for being bow-legged, where the knees curve outward even when the feet are together.
• Bone malalignment: This happens when bones do not line up correctly, which can put too much pressure on certain parts of a joint and cause it to wear out faster.
• Ligament instability: Long-term issues with the ligaments (the tissues that connect bones), such as the Anterior Cruciate Ligament (ACL), may be managed alongside an osteotomy to help stabilize the joint.

Related symptoms people search for

People who may benefit from this procedure often experience symptoms related to joint wear or structural issues. These symptoms can vary depending on which joint is affected, but they often involve discomfort that makes daily activities more difficult.

Common symptoms that can be associated with these conditions include:

• Localized joint pain: Persistent aching or sharp pain that is often felt on one specific side of the knee or hip.
• A feeling of instability: The sensation that the joint might buckle or give way during movement or while standing.
• Visible changes in leg shape: Noticing that the legs appear bowed or that the alignment of the knees has changed over time.
• Stiffness: Difficulty moving the joint through its full range of motion, especially after waking up or sitting for a long time.

If you are experiencing these symptoms, your clinician can perform an evaluation to determine the cause and discuss whether a realignment procedure is a suitable option for your specific needs.

Evidence overview

Osteotomy is a well-established surgical procedure used to realign bones and change how weight is distributed through a joint. Medical literature describes it as a “joint-preserving” surgery. This means the goal is to save the natural joint for as long as possible rather than replacing it immediately with metal or plastic parts.

Research indicates that for the right candidates—often younger, active patients with osteoarthritis limited to one side of the knee—this procedure can effectively relieve pain and improve function. Clinical data suggests that a successful osteotomy may delay the need for a total joint replacement (arthroplasty) for many years.

Safety notes and individualized care

While osteotomy is generally considered safe, every surgery carries potential risks. Your surgical team will take steps to manage common surgical concerns, such as the risk of infection, blood clots (deep vein thrombosis), or stiffness in the joint. Specific risks associated with cutting and realigning bone include:

• Nonunion: The bone may be slow to heal or fail to knit back together completely.
• Nerve or vessel injury: Nerves and blood vessels near the surgical site may be affected.
• Recurrence: Over time, the alignment issue or deformity could return.

Because this surgery relies on the body's ability to heal bone, it is not suitable for everyone. Clinicians carefully screen patients based on specific health factors. For example, evidence suggests that outcomes may be less successful in patients who smoke, have a high body mass index (BMI), or have inflammatory conditions like rheumatoid arthritis. Your doctor will evaluate your bone quality, range of motion, and overall health to determine if this approach is safer and more appropriate for you than a joint replacement.

Sources used

https://www.ncbi.nlm.nih.gov/books/NBK499872