An ostectomy is a surgical procedure defined by the removal, or excision, of all or part of a bone. The term is derived from the Greek “osteo” (bone) and “ectomy” (surgical removal), indicating its function of eliminating bone tissue. This surgery is employed by medical professionals across disciplines, including orthopedics, podiatry, and dentistry, to address specific structural issues within the skeleton.
The decision to perform an ostectomy is typically made when non-surgical treatments have failed to resolve a patient’s condition. The technique requires meticulous planning, often utilizing imaging like X-rays or CT scans, to determine the exact amount and location of bone requiring removal. The procedure is used to achieve several distinct therapeutic outcomes.
Primary Goals of the Procedure
A primary goal of an ostectomy is to correct skeletal alignment or structural deformities. This is often accomplished by removing a precise, wedge-shaped section of bone, allowing the remaining segments to be realigned into a more favorable position. For instance, removing a wedge can help correct angular deformities like bow legs (genu varum) or straighten a hammertoe.
Another goal is removing damaged or abnormal bone tissue. Surgeons perform an ostectomy to excise bone compromised by disease, such as localized infection, necrosis, or a non-cancerous tumor. This removal prevents the spread of the condition and restores the health of the surrounding bone structure.
The procedure is also used to relieve pressure or create space within a joint or bony structure. This applies when removing an abnormal bony outgrowth, such as an osteophyte or bone spur, which causes pain by rubbing against tendons or nerves. Excising the excess bone restores smooth joint movement and alleviates chronic pain.
Common Areas Where Ostectomies Are Performed
Ostectomy is a common technique in orthopedic surgery, particularly for addressing issues in long bones and major joints. It may be performed on the femur or tibia near the knee to shift the load-bearing axis of the limb, relieving pressure on damaged joint cartilage. This approach can help delay the need for a total joint replacement, especially in patients with early-stage osteoarthritis.
Podiatric surgery utilizes ostectomies to correct foot deformities that affect mobility and cause pain. A common example is removing a portion of the metatarsal bone during bunion correction surgery to realign the big toe joint. Partial excision may also be performed on smaller bones to shorten or reposition them, correcting painful conditions like metatarsalgia or chronic dislocations.
In oral and maxillofacial surgery, ostectomies are performed on the jawbone or alveolar ridge (the bone that holds the teeth). A dentist or oral surgeon may remove bone tissue to eliminate deep periodontal pockets around a tooth, a necessary step in managing advanced gum disease. The procedure can also reshape the jawbone to prepare for dental implants or correct skeletal alignment issues affecting chewing and speech.
Understanding the Surgical and Recovery Process
The surgical process begins with the administration of anesthesia, typically general or regional. The surgeon makes an incision to access the bone, using specialized instruments like saws, burrs, or chisels, to precisely remove the predetermined section. For alignment procedures, the remaining bone fragments are secured using internal fixation hardware (plates, screws, or wires) to hold the new position during healing.
Immediately following the procedure, patients are monitored for pain and swelling, managed with medication and ice. Depending on the surgery’s extent, a short hospital stay (often one to two days) may be necessary to ensure pain control and safe mobility. The surgical site is often immobilized with a cast, brace, or splint to protect the bone and support the new alignment.
The recovery timeline is variable, but bone healing, or consolidation, generally takes six to twelve weeks for major bones like the tibia or femur. During the initial six weeks, patients are restricted from bearing weight on the affected limb to prevent stress on the healing site. Imaging tests, such as X-rays, are performed regularly to confirm correct bone healing.
Physical therapy is a fundamental component of recovery, often beginning soon after surgery to maintain muscle strength and prevent joint stiffness. Rehabilitation shifts from gentle range-of-motion exercises to strengthening and gait training as the bone stabilizes. Full return to normal activities can take six months to a year, requiring adherence to the structured physical therapy plan to maximize the surgical outcome.