What is Rotational Osteotomy?
Rotational osteotomy is a surgical procedure employed in the treatment of rotational deformities of the extremities in children. The deformity most often occurs due to rotation of the limbs at birth or due to neurological problems such as cerebral palsy. The malformation is commonly caused by the rotation of the bones, such as the thighbone (femur) and shinbone (tibia), which results in the inward or outward turning of the legs and feet. Rotational osteotomy surgery can also be performed to correct other cases of rotational bone deformities, such as in the forearm, humerus, pelvis, hips, knees, and fingers.
Osteotomy refers to the surgical cutting of a bone to change its length, shape, or alignment. Rotational osteotomy involves cutting the bone and rotating it to straighten the bone, followed by application of metal plates and screws to hold the bone in place while it heals.
Indications for Rotational Osteotomy Surgery
Some of the indications for rotational osteotomy surgery include:
- Leg length discrepancy
- Varus or valgus bone deformity
- Rotational malalignments of the bone
- Developmental dysplasia of the hip (DDH)
- Coxa vara (hip deformity)
- Fibrous dysplasia
- Malunions and nonunions
- Metatarsus adductus (curved foot)
- Blount disease (tibia vara)
- Cerebral palsy
Preparation for Rotational Osteotomy Surgery
Preoperative preparation for rotational osteotomy will involve the following steps:
- A thorough examination of the patient’s limb is performed by the physician that involves measurement of the clinical malformations (angular, rotational, or translational) and limb lengths.
- Physical exam also involves assessment of gait pattern, long bone torsion, ligamentous laxity, and patellar tracking.
- Depending on the patient’s medical history, social history, and age, the patient may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if the patient has allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that the patient is taking.
- The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- The patient should not consume any solids or liquids at least 8 hours prior to surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Rotational Osteotomy Surgery
Rotational osteotomy is usually performed under general anesthesia and involves the following steps:
- An incision is made over the bone where the osteotomy is to be performed.
- The underlying subcutaneous fat and muscles are retracted to expose the affected bone.
- Your surgeon performs an osteotomy, and the bone is rotated and repositioned to attain a perfect angle.
- In some cases, such as femoral rotational osteotomy, the socket is also suitably trimmed to facilitate a better fit for the femoral head inside the socket.
- After confirming the desired position, metal plates and screws are placed to hold the bone in this new position, until it is completely healed.
- These plates and screws may need to be taken out once complete healing is accomplished in a year or two.
- All surrounding tissues and structures are restored to their normal anatomic position.
- Finally, the incision is closed with sutures and sterile dressings are applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery will involve the following steps:
- The patient will be transferred to the recovery area to be monitored until the patient is awake from the anesthesia.
- The patient’s nurse will monitor the blood oxygen level and other vital signs as the patient recovers.
- The patient may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Medications may also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea.
- Antibiotics are prescribed to address the risk of surgery-related infection.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- The patient is encouraged to walk with assistance as frequently as possible to prevent risk of blood clots.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- The patient should refrain from strenuous activities and lifting heavy weights for the first couple of months. Gradual increase in activities over a period of time is recommended.
- A physical therapy protocol may be recommended if necessary to help strengthen muscles and optimize joint function.
- Most patients will be able to resume normal activities within 2 to 3 weeks with certain activity restrictions.
- A periodic follow-up appointment will be scheduled to monitor the progress.
Risks and Complications
Rotational osteotomy surgery is a relatively safe procedure; however, as with any surgical procedure, it does carry some risks and complications, including:
- Blood clots
- Joint stiffness
- Loss of function
- Injury to nerves and blood vessels
- Anesthetic-related complications
- Implant failure
- Revision surgery