Realignment Surgery

What is Realignment Surgery?

Realignment surgery, also known as osteotomy, is a surgical procedure used to correct misalignments or deformities in bones or joints. It involves cutting and repositioning the bones to improve their alignment and restore normal function. 


Who is Suitable for Realignment Surgery?

Generally, individuals who may benefit from realignment surgery include:

  • Patients with Symptomatic Malalignment: Those experiencing pain, instability, or functional limitations due to bone or joint misalignment are potential candidates for realignment surgery.
  • Conservative Treatment Failure: Patients who have tried conservative treatments such as physical therapy, medications, or bracing without adequate relief of symptoms may be considered for surgery.
  • Younger, Active Patients: If the misalignment or deformity is impacting a younger individual's quality of life or ability to participate in physical activities, surgery may be recommended to prevent long-term complications and preserve joint function.
  • Healthy Individuals: Generally, patients with good overall health and who do not have significant medical comorbidities are better suited for surgery and may experience better outcomes.
  • Realistic Expectations: Patients who have realistic expectations regarding the potential outcomes of surgery, including the recovery process and limitations following the procedure, are more likely to be suitable candidates.


Benefits of Realignment Surgery

Realignment surgery offers several benefits for patients with bone or joint misalignments or deformities. Some of the key benefits include:

  • Pain Relief: Realignment surgery can alleviate pain and discomfort associated with osteoarthritis or joint instability by correcting misalignments or deformities.
  • Improved Function: Realignment surgery aims to restore normal alignment and biomechanics, which can improve joint function and mobility and allow patients to perform daily activities with greater ease.
  • Delay or Prevention of Joint Replacement: In some cases, realignment surgery may delay or even prevent the need for joint replacement surgery by addressing underlying structural issues and preserving joint integrity.
  • Enhanced Joint Stability: Realignment surgery can restore proper alignment and enhance joint stability, reducing the risk of falls, instability, and further injury.
  • Better Long-Term Outcomes: In certain cases, realignment surgery can lead to better long-term outcomes than non-surgical treatments, particularly for younger patients with progressive deformities or malalignments.


Types of Realignment Surgery

Types of realignment surgery vary depending on the location and nature of the misalignment or deformity. Some common types include:

  • High Tibial Osteotomy (HTO): This procedure corrects varus (bowleg) deformity or unloads the arthritic compartment of the knee by altering the alignment of the tibia (shin bone) relative to the femur (thigh bone).
  • Distal Femoral Osteotomy (DFO): DFO corrects valgus (knock-knee) deformities by realigning the distal portion of the femur.
  • Hip Osteotomy: Various types of hip osteotomies exist, including periacetabular osteotomy (PAO) for hip dysplasia and femoral osteotomy for femoroacetabular impingement (FAI), aiming to improve hip joint congruity and stability.
  • Ankle Osteotomy: Realignment surgeries for the ankle can include procedures such as medializing calcaneal osteotomy for flatfoot deformity or supra malleolar osteotomy for ankle arthritis or instability.
  • Limb Lengthening Procedures: Limb lengthening surgeries involve gradual distraction osteogenesis to lengthen bones and correct limb length discrepancies.


Alternative Options to Realignment Surgery

While realignment surgery can be highly effective in certain cases, it may not be suitable for everyone. Alternative options to realignment surgery include:

  • Conservative Treatments: Non-surgical options such as physical therapy, bracing, activity modification, and pain management techniques may provide relief for some patients with mild to moderate symptoms.
  • Joint Injections: Corticosteroids, hyaluronic acid, or platelet-rich plasma (PRP) injections may help reduce pain and inflammation in joints affected by arthritis or other conditions, although the effects are often temporary.
  • Joint Replacement Surgery: For individuals with advanced joint degeneration or irreparable damage, joint replacement surgery (such as total hip or knee replacement) may be recommended as an alternative to realignment surgery.
  • Orthotics or Shoe Inserts: Custom orthotics or shoe inserts can help improve alignment and reduce pressure on specific areas of the foot or ankle, providing symptomatic relief for conditions like flatfoot or high arches.
  • Lifestyle Modifications: Weight management, exercise, and activity modifications can help alleviate symptoms and slow the progression of certain musculoskeletal conditions, reducing the need for surgical intervention.


Preparation for Realignment Surgery

Before undergoing realignment surgery, patients must take several steps to ensure they are well-prepared for the procedure and maximise their chances of a successful outcome. Here's what to do before realignment surgery:

  • Consultation and Evaluation: Consult your orthopaedic surgeon thoroughly to discuss your symptoms, medical history, and treatment options. Your surgeon will perform a physical examination and may order imaging tests such as X-rays or MRI scans to assess the extent of your misalignment or deformity.
  • Medical Clearance: Complete any preoperative medical evaluations or tests recommended by your surgeon or primary care physician. This may include blood tests, electrocardiogram (ECG), or other screenings to ensure you are medically fit for surgery.
  • Medication Management: Review your current medications with your healthcare team, including prescription medications, over-the-counter drugs, and supplements. Your surgeon may advise you to adjust or temporarily discontinue certain medications before surgery to reduce the risk of complications.
  • Quit Smoking: If you smoke, it's essential to quit smoking before surgery, as smoking can impair healing, increase the risk of infection, and negatively impact surgical outcomes. Your surgeon may recommend smoking cessation programs or resources to help you quit.
  • Physical Therapy: Your surgeon may recommend preoperative physical therapy to strengthen surrounding muscles, improve joint mobility, and optimise your physical condition before surgery. Physical therapy can also help you learn exercises and techniques to aid in your recovery post-surgery.
  • Prepare Your Home: Make any necessary arrangements at home to ensure a safe and comfortable recovery following surgery. This may include arranging for assistance with daily tasks, installing assistive devices such as handrails or shower chairs, and organising your living space to minimise tripping hazards.


Realignment Surgery Procedure

The general steps involved in realignment surgery may include:

  • Anaesthesia: Before the surgery begins, you will be given anaesthesia to ensure you are comfortable and pain-free throughout the procedure. Your surgeon and anesthesiologist will determine the type of anaesthesia used (general or regional anaesthesia) based on your medical history and the nature of the surgery.
  • Incision: Your surgeon will make one or more incisions over the affected area to access the bones or joints targeted for realignment. The size and location of the incisions will depend on the specific surgical approach and the complexity of the procedure.
  • Bone Reshaping: Using specialised surgical instruments, your surgeon will carefully cut and reshape the bones to correct the misalignment or deformity. This may involve removing excess bone, repositioning the bone segments, or adding bone grafts or implants to achieve the desired alignment.
  • Fixation: Once the bones are properly aligned, your surgeon may use internal fixation devices such as screws, plates, or rods to stabilise the bones and facilitate proper healing. In some cases, external fixation devices may be temporarily applied to the outside of the body to support the bones during the initial healing phase.
  • Closure: After the realignment, the incisions will be carefully closed with sutures or surgical staples. Sterile dressings may be applied to the incision sites to protect the wounds and promote healing.


Realignment Surgery Recovery Plan

Following realignment surgery, it's normal to experience some discomfort, swelling, and limited mobility in the affected area. Here's what to expect during the recovery period:

  • Hospital Stay: Depending on the type of surgery and your circumstances, you may need to stay in the hospital for monitoring and initial rehabilitation for a few days following surgery. Your healthcare team will provide pain management medications and instructions for postoperative care.
  • Activity Restrictions: Your surgeon will provide specific guidelines regarding weight-bearing restrictions, activity limitations, and rehabilitation exercises to promote healing and prevent complications. Following these instructions carefully is important to avoid putting undue stress on the newly realigned bones or joints.
  • Physical Therapy: In the weeks and months following surgery, you will likely participate in a structured physical therapy program to regain strength, flexibility, and function in the affected area. Your physical therapist will tailor the rehabilitation plan to your individual needs and goals, gradually increasing the intensity of exercises as you progress.
  • Pain Management: You may experience discomfort or pain during the initial stages of recovery, which can usually be managed with prescription pain medications, over-the-counter pain relievers, ice packs, and elevation of the affected limb.
  • Follow-up Appointments: Attend all scheduled follow-up appointments with your surgeon to monitor your progress, assess healing, and address any concerns or complications that may arise. Your surgeon may order additional imaging studies, such as X-rays or CT scans, to evaluate the alignment of the bones and ensure proper healing.
  • Gradual Return to Activities: As you recover, you will gradually be able to resume normal activities and gradually increase the intensity of your exercise regimen under the guidance of your healthcare team. It's important to listen to your body and avoid overexertion to prevent setbacks in your recovery.


Realignment Surgery Prognosis

The prognosis for realignment surgery is generally positive for many patients, with significant improvements in pain, function, and quality of life. However, discussing the potential risks, benefits, and expected outcomes of surgery with your doctor is essential to make informed decisions about your treatment plan.


Realignment Surgery Risks

Some common risks associated with realignment surgery include:

  • Infection
  • Blood Clot
  • Nerve or Blood Vessel Injury
  • Implant Failure
  • Delayed Healing
  • Joint Stiffness
  • Complications with Anesthesia


What if Realignment Surgery is Delayed?

In some cases, delaying surgery may result in worsening symptoms, progression of the deformity or misalignment, and increased risk of complications or long-term damage to the affected joint or bones. Additionally, delaying surgery may prolong pain, functional limitations, and reduced quality of life for the patient.


If you are considering realignment surgery but are unsure about the timing or have concerns about delaying the procedure, discuss your options with your orthopaedic surgeon. They can provide personalised guidance and recommendations based on your specific condition and help you decide on the most appropriate course of action.

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