An osteotomy is a surgical procedure where a surgeon deliberately cuts a bone to reshape, realign, or reposition it. The cut bone is then shifted into a better position and held in place with metal plates and screws while it heals. Osteotomies are performed on nearly every bone in the body, from the jaw to the spine to the legs, and the goal is always the same: fix a structural problem that’s causing pain, dysfunction, or progressive joint damage.
Why Bone Cutting Fixes Joint Problems
Bones aren’t just rigid supports. They’re load-bearing structures, and the angle at which they meet at a joint determines how weight and pressure get distributed across the cartilage surface. When bones are misaligned, whether from birth, injury, or years of wear, one side of a joint takes a beating while the other side barely works. That uneven loading grinds down cartilage in the overloaded zone, leading to arthritis.
By cutting the bone and changing its angle, the surgeon shifts weight away from the damaged portion of the joint and onto healthier cartilage. This can relieve pain, slow the progression of arthritis, and in many cases delay or prevent the need for a full joint replacement. That last point matters most for younger, active people who would otherwise face a replacement that might wear out and need redoing later in life.
Common Types of Osteotomy
Knee (High Tibial Osteotomy)
The most well-known osteotomy targets the upper shinbone, just below the knee. It’s used when arthritis has worn down the cartilage on one side of the knee, usually the inner side. A “bowlegged” alignment pushes too much force through that inner compartment, so the surgeon cuts the top of the tibia and adjusts its angle to redistribute weight toward the healthier outer compartment. Long-term studies show a 10-year survival rate of about 87%, meaning roughly 9 out of 10 patients still haven’t needed a knee replacement a decade later. When the osteotomy is combined with cartilage repair techniques, that rate climbs to about 94%.
Hip (Periacetabular Osteotomy)
In this procedure, the surgeon cuts the bone around the hip socket and repositions it to provide better coverage of the ball of the femur. It’s most commonly performed in younger adults with hip dysplasia, a condition where the socket is too shallow to properly contain the joint. Without correction, the poor fit accelerates cartilage breakdown and leads to early hip arthritis.
Jaw (Orthognathic Surgery)
Osteotomies of the jaw correct bite problems and facial asymmetry. One of the most common is a bilateral sagittal split osteotomy, where the lower jaw is cut on both sides and repositioned forward or backward to fix an underbite, overbite, or uneven jaw. These are typically performed by oral and maxillofacial surgeons and often coordinated with orthodontic treatment.
Spine
Spinal osteotomies correct severe deformities like kyphosis (a pronounced forward curve in the upper back). The goal is to restore balance so the patient can stand upright without compensating elsewhere in the body, while also relieving pain and preventing the deformity from worsening.
Opening Wedge vs. Closing Wedge
The two main cutting techniques are the opening wedge and the closing wedge. In an opening-wedge osteotomy, the surgeon cuts partway through the bone, opens the gap to the desired angle, and fills it with bone graft material or a synthetic substitute. In a closing-wedge osteotomy, the surgeon removes a small wedge-shaped piece of bone and closes the gap, bringing the two surfaces into direct contact.
Each approach has tradeoffs. Closing-wedge cuts create bone-to-bone contact, which tends to heal more reliably and allows earlier weight bearing. Opening-wedge cuts give the surgeon more ability to fine-tune the correction angle during the procedure but may require bone grafting and carry a slightly higher risk of delayed healing. The choice depends on the specific deformity, the location, and what else the surgeon needs to address during the operation.
How the Procedure Works
Before surgery, your surgical team will take detailed images to plan exactly where and at what angle to cut. This typically includes standing, full-length X-rays of the limb so the alignment can be measured under your body weight. Many centers now also use CT scans to build three-dimensional models of your bones for more precise planning. The two imaging types are sometimes digitally combined, since CT is done lying down and doesn’t capture how your bones behave when you’re standing.
During the surgery itself, the surgeon uses guide wires placed under X-ray guidance to mark the cutting plane. An oscillating saw makes the primary cut through about three-quarters of the bone, and thin chisels complete the cut through the remaining portion. This controlled approach reduces the risk of cracking the bone in an unintended direction. Once the bone is repositioned at the planned angle, it’s fixed in place with metal plates and screws. In some cases, a single large screw crosses the osteotomy site to add compression, while a plate along the bone surface provides stability.
Risks and Complications
Osteotomy is a significant surgical procedure, and complications do occur. The most important ones to understand are nonunion (the bone fails to heal across the cut), delayed healing, infection, nerve injury, and blood clots.
Nonunion and delayed healing rates depend heavily on the type and location of the osteotomy. A study of wrist osteotomies found that about 1 in 6 patients experienced nonunion or delayed healing, with the risk higher in “distraction-type” cuts where the gap is opened and filled with graft rather than cuts where direct bone contact is maintained. That same study reported an overall complication rate of nearly 50% for distal radius osteotomies, though many complications were minor. Surgeon experience with the specific procedure appears to influence outcomes.
Nerve injury is a particular concern around the knee, where the peroneal nerve runs close to the surgical site on the outer side. Damage to this nerve can cause foot drop, a difficulty lifting the front of the foot. Hardware irritation, where the plates or screws cause discomfort under the skin, is also common and occasionally requires a second surgery to remove the metal once the bone has healed.
Recovery Timeline
Bone healing after osteotomy follows the same biological process as any fracture, but it happens on a predictable schedule because the cut is clean and the bone is stabilized with hardware. In the first two weeks, a blood clot forms at the cut site and the body begins laying down a soft tissue bridge. Over the next several weeks, that bridge mineralizes into a preliminary callus. Full remodeling of the bone continues for months to years after the initial healing.
What this looks like in practice depends on where the osteotomy was performed. For hip osteotomies, most surgeons start partial weight bearing with crutches on the first or second day after surgery. You’ll typically stay on partial weight bearing for six to eight weeks, with full weight bearing allowed somewhere between eight and twelve weeks. Some protocols are more conservative, extending partial weight bearing to twelve weeks.
For knee osteotomies, closing-wedge techniques generally allow earlier weight bearing because of the direct bone contact. Opening-wedge procedures may require a longer protected period. Regardless of the technique, expect to use crutches or a walker for at least six weeks and to spend several months in physical therapy rebuilding strength and range of motion. Most people return to light daily activities within two to three months and to more demanding physical activity between four and six months, though full recovery can take up to a year.
Who Is a Good Candidate
Osteotomy works best for people who have a clear structural malalignment contributing to their joint pain and who still have healthy cartilage on at least one side of the joint. The ideal candidate is younger and active enough that a joint replacement would likely wear out and need to be redone. If arthritis has already spread to the entire joint surface, an osteotomy won’t have a healthy zone to redirect weight toward, and a replacement becomes the better option.
The procedure is also used to correct congenital deformities like hip dysplasia and limb-length differences, traumatic malunions where a fracture healed in a bad position, and jaw misalignment that affects chewing or breathing. In each case, the underlying logic is the same: the bone’s current shape or position is causing a problem, and cutting and repositioning it can solve or significantly improve it.