Tibial Derotational Osteotomy - Know All About It

What Is Tibial Derotational Osteotomy?

Tibial derotational osteotomy is a surgical procedure designed to correct rotational deformities of the tibia, the larger bone in the lower leg. It involves realigning the tibia to restore its proper anatomical position, which helps improve gait and overall lower limb function. This procedure is commonly performed in individuals with conditions such as congenital tibial torsion or rotational malalignment following fractures. By addressing these rotational abnormalities, tibial derotational osteotomy aims to enhance mobility, alleviate pain, and improve the quality of life for patients affected by these conditions.

What Are the Indications?

Tibial derotational osteotomy is indicated in various conditions and situations, including:

• Congenital Tibial Torsion: This refers to a rotational deformity of the tibia present at birth. Tibial derotational osteotomy can be performed to correct excessive internal or external rotation of the tibia and improve the alignment of the lower leg.

• Rotational Malalignment Following Fractures: When a fracture of the tibia occurs, it can sometimes result in rotational malalignment during the healing process. Tibial derotational osteotomy may be necessary to realign the bone and restore proper rotational alignment.

• Neuromuscular Disorders: Certain neuromuscular conditions, such as cerebral palsy or muscular dystrophy, can lead to rotational deformities of the lower leg. Tibial derotational osteotomy can be considered as part of the treatment plan to address these deformities and improve functional mobility.

• Persistent Gait Abnormalities: If an individual continues to experience significant gait disturbances or functional limitations despite the fact that conservative treatments, tibial derotational osteotomy may be recommended to correct the rotational deformity and improve overall walking mechanics.

What Are the Contraindications?

While tibial derotational osteotomy is generally a safe and effective procedure, there are specific contraindications that may make it unsuitable for some individuals. These contraindications may include:

• Severe Medical Conditions: If a patient has severe underlying medical conditions, such as uncontrolled diabetes, cardiovascular disease, or compromised immune function, they may not be considered suitable candidates for surgery due to the increased risks associated with anesthesia and surgical procedures.

• Active Infection: If there is an active infection present in the affected limb or surrounding tissues, it may be necessary to resolve the infection before considering tibial derotational osteotomy. Surgery in the presence of an active infection can increase the risk of complications and hinder proper healing.

• Poor Bone Quality: If the bone quality in the tibia is compromised, such as in cases of severe osteoporosis or significant bone loss, it may affect the stability and healing potential after the procedure. In such cases, alternative treatment options may be considered.

• Lack of Patient Compliance: Successful outcomes of tibial derotational osteotomy often require diligent post-operative rehabilitation and physical therapy. If a patient is unable or unwilling to comply with the recommended rehabilitation program, it may affect the overall success of the procedure.

It is essential for patients to undergo a thorough evaluation by an orthopedic surgeon who can assess their individual condition, medical history, and any contraindications to determine if tibial derotational osteotomy is appropriate for them. The surgeon will consider the potential risks and benefits of the procedure and discuss alternative treatment options if necessary.

What Are the Steps?

• Anesthesia: The patient is given medication to sleep and does not feel any pain during the surgery.

• Incision: The surgeon makes a small cut in the leg to access the tibia, which is the larger bone in the lower leg.

• Bone Cutting: The surgeon carefully cuts the tibia in a specific way to fix the rotation problem. This means making a controlled break in the bone.

• Bone Realignment: After the bone is cut, the surgeon adjusts its position to correct the rotation. This helps bring the bone back into the right place.

• Fixation: To keep the bone in its new position, the surgeon uses metal plates, screws, or other devices. This help holds the bone steady while it heals.

• Closure: Once the bone is fixed in the correct position, the surgeon closes the incision with stitches or staples. This helps the skin heal properly.

• Recovery: After the surgery, the patient may need to stay in the hospital for a few days. This allows the medical team to monitor their progress and provide appropriate care.

• Rehabilitation: To regain strength and movement, the patient will work with physical therapists. They will guide the patient through exercises and activities to help them recover and learn to walk properly again.

It is important to note that tibial derotational osteotomy is a specialized surgery performed by trained orthopedic surgeons. The actual procedure may involve additional steps and considerations depending on the specific case.

What Are the Risks Involved?

Like any surgical procedure, tibial derotational osteotomy carries certain risks and potential complications. These can include:

• Infections: There is a risk of developing an infection at the surgical site. This can be treated with antibiotics, but in some cases, additional surgery may be required to address the infection.

• Blood Clots: Surgery can increase the risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism). Medications and special devices may be used to prevent blood clots from forming.

• Nerve or Blood Vessel Damage: There is a small risk of injury to nearby nerves or blood vessels during the procedure, which can result in temporary or permanent complications such as numbness, tingling, or circulation problems.

• Poor Bone Healing: In some cases, the bones may not heal properly, or the bone alignment may not be fully corrected. This can require additional surgeries or prolonged healing time.

• Hardware Issues: The metal plates, screws, or other fixation devices used to hold the bone in place can sometimes cause discomfort and irritation or may require removal in the future.

• Anesthetic Complications: General anesthesia carries inherent risks, such as adverse reactions to medications or breathing difficulties. These risks are typically low but can occur.

• Non-union or Delayed Union: In some cases, the bones may not fully heal or take longer than expected to heal. This can result in a delayed recovery or the need for further interventions.

It is important to discuss these potential risks with your orthopedic surgeon before undergoing the procedure. They will assess your individual situation and provide guidance on managing and minimizing these risks. Adhering to post-operative instructions, attending follow-up appointments, and actively participating in rehabilitation can also help reduce the likelihood of complications and promote a successful recovery.

What Is Post Care?

Post-care following tibial derotational osteotomy may include:

• Immobilization: The patient may need to wear a cast, brace, or use crutches to protect the leg and allow proper healing.

• Pain Management: Pain medication may be prescribed to manage discomfort during the initial recovery period.

• Physical Therapy: Rehabilitation exercises and therapy help regain strength, range of motion, and improve walking mechanics.

• Follow-up Appointments: Regular check-ups with the orthopedic surgeon are essential to monitor healing progress and address any concerns.

• Weight-bearing Restrictions: The surgeon may provide instructions on gradually increasing weight-bearing activities based on the individual's healing progress.

• Wound Care: Proper cleaning and care of the surgical incision site to prevent infection and promote healing.

• Activity Modifications: Activities that put excessive stress on the leg may need to be limited or avoided during the recovery period.

• Patience and Adherence: Following the surgeon's instructions, being patient with the healing process, and actively participating in rehabilitation are crucial for optimal recovery.

It is important for patients to closely follow the post-care guidelines provided by their healthcare team to promote healing, reduce complications, and achieve the best possible outcome.

Conclusion:

In conclusion, the tibial derotational osteotomy is a surgical procedure that effectively addresses rotational deformities of the tibia, offering improved alignment and function for patients. By carefully realigning the tibia, this procedure helps alleviate symptoms and restore normal biomechanics, ultimately enhancing the quality of life for individuals suffering from tibial rotational abnormalities. With advancements in surgical techniques and technology, tibial derotational osteotomy continues to be a valuable treatment option for patients in need.