Osteotomy
A surgical procedure that intentionally cuts a bone and realigns it to shift weight off a damaged area and preserve a native joint.
What the word means
Osteotomy comes from osteo (bone) and tome (a cutting). The surgeon deliberately cuts a bone, usually just above or below a joint, and realigns the pieces to change the angle and shift the weight-bearing load. The bone is then held in the new position with plates and screws until it heals. Unlike fusion or replacement, an osteotomy preserves the joint’s ability to move—it just redistributes the load.
The most common use: knee osteotomy
A high tibial osteotomy (HTO) is the classic application. When the inner (medial) compartment of the knee has arthritis but the outer (lateral) compartment is still healthy, the surgeon cuts the tibia (shinbone) just below the knee and angles it outward. This shifts weight off the damaged medial compartment onto the healthier lateral side. Done in a patient in their 40s or 50s with isolated compartment arthritis, an HTO can provide 10–15 years of pain relief and delay or prevent the need for knee replacement.
Other osteotomy applications
- Bunion correction — the metatarsal bone at the base of the big toe is cut and realigned to straighten the toe.
- Limb realignment — correcting bow-legs (genu varum) or knock-knees (genu valgum) to balance weight distribution.
- Hip osteotomy — less common than knee but used to improve hip socket coverage in cases of impingement or dysplasia.
- Ankle osteotomy — realigning the ankle to correct varus or valgus deformity.
When osteotomy makes sense
Osteotomy is a middle path—more aggressive than conservative care but less final than replacement. It’s considered when:
- Damage is localized to one compartment, not the whole joint.
- The other compartments have relatively healthy cartilage.
- The patient is young enough that delaying replacement by 10–15 years is valuable.
- Conservative treatment has failed but the patient isn’t ready for or doesn’t want replacement.
- There’s an underlying malalignment (bow-legs or knock-knees) that’s contributing to the problem.
Recovery and weight-bearing progression
An osteotomy is major surgery and requires careful healing. Weight-bearing is typically restricted while the bone heals at the osteotomy site. Physical therapy focuses on restoring range of motion and strength. Return to normal activities is gradual, and it may take the better part of a year to feel completely normal. The goal is to buy many years before replacement becomes necessary.