Corrective Osteotomy: Specialists & Information

In corrective osteotomy, the surgeon realigns the affected bones to their anatomically correct position and secures them in place. This process is called osteosynthesis.

This surgical technique, also known as realignment osteotomy, is primarily used on the extremities (leg alignment correction). However, it is also commonly used in oral and maxillofacial surgery (OMS) to correct malocclusions.

Axial deformities in childhood are quite common. A misalignment of the lower extremities can become apparent as early as a child’s first attempts at walking. Strictly speaking, at this early stage, it cannot be considered a misalignment of the knee joint. Rather, it is a longitudinal varus deformity of the lower leg, which gives the appearance of bowlegs.

Normally, the leg axes straighten out during the second year of life. A deviation in the opposite direction also usually normalizes by the age of ten. The normal development of the leg axes is thus complete by puberty.

If a misalignment occurs after the age of ten and is accompanied by reduced femoral neck rotation, the situation is somewhat more problematic. The misalignment

• is visually unappealing,
• affects self-confidence, and
• above all leads to hip pain and
• , if left untreated, to early-onset osteoarthritis.

As a rule, corrective surgery is necessary.

An important aspect of pediatric and adolescent orthopedics is the treatment of legs of different lengths or crooked legs.

Leg alignment issues are much easier to correct in children than in adults. Before puberty, it is still possible to take advantage of the natural growth of the epiphyseal plate. This allows doctors to guide the patient’s growth.

Orthopedic surgeons do this by partially or completely blocking the epiphyseal plate (epiphysiodesis). The procedure is minimally invasive and carries a low risk of complications. To ensure the success of the treatment, the patient should attend all follow-up appointments after surgery.

Epiphysiodesis is also used to inhibit growth in cases of leg length discrepancy.

Bowlegs (valgus deformity) and knock-knees (varus deformity) are the most common deformities of the knee joint. This places excessive stress on either the inner or outer side of the knee joint, leading to cartilage damage. As a result, such misalignments are the main cause of osteoarthritis in the knee joint.

Through alignment correction, the load on the cartilage is redistributed, allowing the articular cartilage to remain intact for longer. Even if cartilage damage has already occurred, the correction can be beneficial: Reducing the load slows the progression of osteoarthritis, alleviates pain, and eliminates an unfavorable compensatory posture.

Corrective osteotomy is a form of joint-preserving knee surgery. It is performed by specialists in orthopedics and trauma surgery. Today, the procedure is minimally invasive.

The goal is not only to correct the misalignment but also to restore the affected joint’s ability to bear weight as quickly as possible.

Before the realignment surgery, doctors first perform an arthroscopy (joint endoscopy). This allows them to assess whether the cartilage damage still permits this procedure.

To precisely determine the two axes, a complete X-ray of the leg is taken while the patient is standing prior to surgery. The surgeon then determines the degree of axial deviation.

A realignment osteotomy is significantly more complex than growth guidance. For this reason, orthopedic surgeons recommend correcting the misalignment as early as possible (preferably during childhood).

Nevertheless, realignment osteotomy is often advisable even in adults to prevent osteoarthritis and the need for future joint replacements.

Treatment of the deformity depends on its severity and the condition of the bone. There are two options to choose from:

• The surgeon cuts the tibia below the tibial plateau from the inner side of the knee joint. He then spreads the bone apart until the leg is aligned as desired. The resulting gap fills in on its own with bone tissue within about twelve months.
• In the second method, the surgeon cuts through the tibia from the outside to the inside, removes a bone wedge, and closes the gap. This realigns the axis.

In both cases, the bone segments are fixed in place with a plate.

In general, the surgery proceeds without complications. The procedure reduces pain and increases the joint’s load-bearing capacity. The joint can now be maintained in its natural position over the long term.

Surgical risks, such as those associated with anesthesia, thrombosis, or inflammation, are always present. Pain may still occur even months later, and residual symptoms cannot be entirely ruled out. Pseudarthrosis is also a risk.

Pseudoarthrosis (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 weight-bearing capacity in the affected bones and significant pain. Pseudoarthrosis primarily occurs in the long bones of the upper and lower legs, the upper and lower arms, or the scaphoid bone (wrist).

Pseudoarthrosis can have many causes. Typical causes include

• osteoporosis,
• diabetes mellitus,
• bone infections, or
• circulatory disorders in the affected bone.

To protect the previously damaged knee joint, the correction is slightly excessive. This is the only way the patient can walk on the healthy cartilage again. In cases involving rotational realignment, there is a risk of rotational malalignment.

A 4-day hospital stay is standard following the surgery. On the second or third day after surgery, the corrected leg is X-rayed again, and the position of the implants is checked.

After the procedure, the leg may bear up to 40 kg of weight, so patients will need walking canes. The physical therapist will explain the proper walking technique. Patients must manage with this restriction for about four weeks.

The knee joint should be bent and straightened immediately. Physical therapy during the first six weeks also includes strength training to build muscle. As a rule, patients themselves know best how to assess their symptoms. If something seems suspicious to them, they should inform their treating physician immediately.

After about six weeks, light activities such as office work are possible again. Patients should avoid physical exertion for at least six weeks.

At an orthopedic rehabilitation clinic, specialists and therapists from various disciplines develop a personalized treatment plan. The goal is to facilitate the fastest possible recovery and a successful return to work and daily life.

The treatment focuses on strengthening the muscles surrounding the joints. Only muscle building ensures long-term stability, which is why moderate exercise 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 progress. Your primary care physician or orthopedic surgeon may prescribe follow-up therapy sessions if necessary.