Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); after epiphyseal closure
CPT4 code
Name of the Procedure:
Osteotomy, Proximal Tibia (Including Fibular Excision or Osteotomy)
Summary
Osteotomy of the proximal tibia is a surgical procedure that involves cutting and realigning the upper part of the tibia (shinbone) and sometimes the fibula (the smaller bone in the lower leg) to correct deformities like bowleg (genu varus) or knock-knee (genu valgus). This procedure is typically done after the growth plates (epiphyseal plates) have closed.
Purpose
This procedure is intended to correct leg deformities such as bowlegs or knock-knees, which can cause pain, discomfort, and mobility issues. The goal is to restore proper alignment of the leg bones to improve function, reduce pain, and prevent further joint damage.
Indications
- Significant bowleg (genu varus) or knock-knee (genu valgus)
- Pain or discomfort in the knees or lower legs
- Difficulty walking or performing daily activities
- Previous unsuccessful non-surgical treatments
- Skeletal maturity indicated by the closure of growth plates
Preparation
- Fasting for a specified period before surgery
- Medication adjustments as advised by the surgeon
- Pre-operative imaging studies (e.g., X-rays, MRI, CT scans)
- Blood tests and overall health assessment
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made over the upper part of the tibia.
- The surgeon cuts the tibia and, if necessary, the fibula to realign the bones.
- Plates, screws, or external fixation devices are used to hold the bones in their new position.
- The incision is closed with sutures or staples, and a bandage is applied.
Duration
The procedure typically takes about 1 to 2 hours, depending on the complexity of the case.
Setting
The surgery is usually performed in a hospital or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Blood clots
- Nerve or blood vessel damage
- Delayed bone healing or non-union
- Implant issues (e.g., loosening or breakage)
- Persistent pain or stiffness
Benefits
- Improved alignment of the legs
- Reduction or elimination of pain
- Enhanced mobility and function
- Prevention of further joint damage
- Long-term improvement in quality of life
Recovery
- Hospital stay for a few days post-surgery
- Pain management with medications
- Physical therapy to regain strength and mobility
- Avoid weight-bearing activities for several weeks
- Follow-up appointments to monitor healing
- Full recovery may take several months
Alternatives
- Physical therapy and exercises
- Orthotic devices (e.g., braces)
- Medications for pain and inflammation
- Minimally invasive procedures (if applicable)
- Each alternative has its own pros and cons, with non-surgical options typically being less invasive but possibly less effective for severe deformities.
Patient Experience
During the procedure, the patient will not feel pain due to general anesthesia. Post-surgery, patients may experience discomfort, swelling, and pain at the surgical site. These symptoms can be managed with medication and proper care. The recovery period will involve limited mobility initially, followed by gradual rehabilitation with physical therapy to restore function and strength.