Corrective osteotomy is a surgical correction of bone deformities or the removal of bone fragments. This often requires (re-)cutting of the affected bone.
Here you will find further information as well as selected specialists and centers for corrective osteotomy.
During a corrective osteotomy, the surgeon puts the affected bones back into an anatomically correct position and fixes them. This fixation is called osteosynthesis.
The surgical technique, also known as corrective osteotomy, is mainly used on the extremities(leg axis correction). However, it is also commonly used in oral and maxillofacial surgery (maxillofacial surgery ) to correct malocclusions.
Axial misalignments are quite common in childhood. A misalignment of the lower extremities can already become apparent during the first attempts at walking. At this early stage, there can be no question of a misalignment of the knee joint. Rather, it is an elongated varus position of the lower leg, which gives the impression of bow legs.
The leg axes normally straighten in the second year of life. A deviation in the other direction usually normalizes by the age of ten. The normal development of the leg axes therefore ends at puberty.
If a malalignment occurs after the age of ten and is accompanied by a reduced rotation of the femoral neck, the situation is somewhat more problematic. The deformity
Corrective surgery is usually necessary.
An important task of pediatric and adolescent orthopaedics is the treatment of legs of different lengths or crooked legs.
Axial deformities are much easier to correct in children than in adults. Before puberty, the natural growth of the epiphyseal joint can still be utilized. This allows doctors to guide the patient's growth.
Orthopaedic surgeons do this by partially or completely blocking the epiphyseal joint (epiphysiodesis). The procedure is only slightly invasive and has few complications. To ensure the success of the treatment, the patient should attend all check-ups after the operation.
Epiphysiodesis is also used to inhibit growth in cases of leg length discrepancy.
Corrective osteotomy can also be used to treat a leg length discrepancy © rumruay | AdobeStock
Bowlegs (valgus deformity) and knock-knees (varus deformity) are the most common malalignment of the knee joint. As a result, the inner or outer part of the knee joint is subjected to heavy strain on one side, causing cartilage damage. Such misalignments are therefore the main cause of osteoarthritis in the knee joint.
With the help of an axis correction, the load acting on the cartilage is redistributed and the joint cartilage remains intact for longer. The correction can also be useful if cartilage damage has already occurred: The relief slows down the progression of osteoarthritis, eliminates pain and an unfavorable relieving posture.
Corrective osteotomy belongs to the field of joint-preserving knee surgery. Specialists in orthopaedics and trauma surgery are responsible for this. Today, the procedure is minimally invasive.
Theaim is not only to straighten the deformity, but also to enable the affected joint to bear weight quickly.
Before the repositioning operation, the doctors first perform an arthroscopy (joint endoscopy). This allows them to assess whether the cartilage damage still allows this procedure to be carried out at all.
In order to determine the two axes precisely, a complete X-ray of the leg in a standing position is taken before the operation. The surgeon then determines the degree of axial deviation.
A realignment osteotomy is considerably more complex than growth control. Orthopaedic surgeons therefore recommend correcting the deformity as early as possible (preferably in childhood).
Nevertheless, corrective osteotomy is also often useful in adults in order to avoid osteoarthritis and later prostheses.
The treatment of the malalignment depends on its severity and the condition of the bone. There are two options to choose from:
In both cases, the bone parts are fixed with a plate.
The operation is generally problem-free. The procedure reduces pain and increases the joint's load-bearing capacity. The joint can now be kept in its natural position in the long term.
Surgical risks such as anesthesia risks, thrombosis or inflammation are always present. Pain can still occur months later and residual symptoms cannot be completely ruled out. Pseudarthrosis is also a risk.
Pseudarthrosis (false joint) refers to the failure of bone fractures to heal. It lasts for at least six months. Pseudoarthrosis is associated with a lack of load-bearing capacity of the affected bones and considerable pain. Pseudoarthrosis mainly occurs in the long bones of the upper and lower leg or upper and lower arm or in the scaphoid bone (wrist).
Pseudarthrosis can have many causes. Typical causes are
In order to protect the damaged knee joint, it is slightly overcorrected. This is the only way the patient can walk on the healthy cartilage area again. There is a risk of rotational malalignment in the case of adjustments involving rotation.
A 4-day hospital stay is usual after the operation. On the second or third day after the operation, the corrected leg is x-rayed again and the position of the implants is checked.
After the operation, it can be partially loaded up to 40 kg, so patients need walking sticks. The physiotherapist explains the correct walking technique. Patients have to cope with this restriction for around four weeks.
The knee joint should be flexed and extended immediately. Physiotherapy in the first six weeks also includes strength training to build up muscles. As a rule, patients themselves know best how to assess complaints. If anything seems suspicious, they should inform their doctor immediately.
After about six weeks, light activities such as office work are possible again. Patients should avoid physical exertion for at least six weeks.
In an orthopaedic rehabilitation clinic, specialists and therapists from several disciplines put together an individual therapy plan. The aim is to enable the patient to recover as quickly as possible and successfully return to work and everyday life.
The measures focus on strengthening the muscles surrounding the joints. Only muscle development ensures long-term stability, which is why moderate sport is extremely important. The patient's progress is closely monitored.
As a rule, you will also need to continue exercising at home to consolidate your success. The family doctor or orthopaedist can prescribe follow-up sessions if necessary.
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