A femoral osteotomy is a surgical procedure that involves cutting and reshaping the thigh bone (femur) to correct deformities, improve joint alignment, and relieve pain. This surgery is often recommended for patients with conditions like osteoarthritis, hip dysplasia, or leg length discrepancies where misalignment causes excessive wear on joints.
By repositioning the bone, surgeons can redistribute weight-bearing forces more evenly across the joint, potentially delaying or even preventing the need for joint replacement. The procedure has been performed for decades, but modern techniques have significantly improved precision and recovery times.
Patients considering this surgery often have questions about what to expect. This guide will walk you through every aspect of femoral osteotomy - from determining if you're a candidate to full recovery - with clear, compassionate information to help you make informed decisions about your orthopedic health.
Femoral osteotomy isn't for everyone, but it can be life-changing for the right candidates. The most common reasons for this procedure include:
Ideal candidates are typically active individuals who have persistent pain despite conservative treatments (physical therapy, medications, injections) and show joint damage visible on X-rays but still have preserved joint cartilage. Your orthopedic surgeon will evaluate your age, activity level, joint health, and specific anatomy to determine if this procedure could benefit you.
There are several variations of femoral osteotomy, each designed to address specific anatomical issues:
This procedure removes a wedge of bone from the outer femur to shift weight bearing to the healthier side of the joint. It's commonly used for osteoarthritis affecting the outer (lateral) compartment of the knee or hip.
The opposite of varus, this removes an inner wedge to correct bowlegged alignment and redistribute weight to the outer joint compartment.
Corrects twisting deformities of the femur that can cause patellar instability or gait abnormalities. The bone is cut and rotated to its proper position.
Adjusts leg length by either removing a bone segment (shortening) or gradually stretching the bone (lengthening with external fixation devices).
Your surgeon will choose the specific technique based on your imaging studies, physical exam, and surgical goals. Modern methods often use computer navigation or patient-specific guides for enhanced precision.
Proper preparation significantly impacts your surgical experience and recovery. Here's what to expect in the weeks before your procedure:
You'll undergo comprehensive testing including blood work, EKG, and advanced imaging (CT scans or 3D reconstructions) to plan your surgery. Any medical conditions like diabetes or hypertension will need optimization.
Many surgeons recommend "prehab" - physical therapy to strengthen muscles around the joint before surgery. This makes rehabilitation easier and may improve outcomes.
Since you'll be on crutches or a walker temporarily, prepare your home by:
You'll typically stop eating 8 hours before surgery and shower with special antiseptic soap. Arrange for someone to drive you and stay with you for at least the first 24-48 hours post-op.
Understanding what happens during surgery can alleviate anxiety. Here's a general overview (your experience may vary based on your specific case):
You'll receive general anesthesia (fully asleep) or spinal/epidural anesthesia (numb from waist down) with sedation. Your anesthesiologist will recommend the best option for you.
The surgeon makes an incision (typically 4-6 inches) over the surgical site. For hip procedures, this is usually on the side of the upper thigh; for knee-related osteotomies, just above the knee.
Using specialized guides and real-time imaging, the surgeon makes precise cuts in the femur. The exact technique depends on whether you're having a wedge removed (as in varus/valgus) or a rotational adjustment.
The bone is repositioned into its corrected alignment. Plates and screws (usually titanium) hold the bone securely in its new position while it heals. Some surgeons use intramedullary nails instead.
The incision is closed with sutures or staples, dressed, and you're moved to recovery. The entire procedure typically takes 2-3 hours, plus time in the recovery room.
Note: Some centers offer minimally invasive techniques with smaller incisions, potentially reducing pain and speeding recovery. Ask your surgeon if this might be an option for you.
Recovery from femoral osteotomy is a gradual process requiring patience and commitment to rehabilitation. Here's what to expect:
Most patients stay 2-4 days post-op for pain management and initial physical therapy. You'll begin walking with crutches or a walker within 1-2 days, bearing only partial weight on the operated leg.
This is the critical bone-healing phase:
As healing progresses:
By this stage, most patients:
Complete healing takes 9-12 months, though many feel significantly better by 6 months. High-impact activities may need to be limited long-term to protect the joint.
While femoral osteotomy is generally safe, all surgeries carry some risks. Being informed helps you recognize potential issues early:
Contact your surgeon immediately if you experience: fever >101°F, increasing pain/swelling, wound drainage, or sudden shortness of breath (possible blood clot).
Femoral osteotomy success depends on proper patient selection, surgical technique, and rehabilitation compliance. Research shows:
Factors improving success include maintaining a healthy weight, adhering to activity modifications, and continuing prescribed exercises long-term. Regular follow-ups help monitor joint health over time.
Q: How painful is femoral osteotomy recovery?
A: Pain is typically worst in the first 3-5 days, well-controlled with medications. Most patients transition to over-the-counter pain relievers within 2-3 weeks. The bone itself isn't extremely painful once healing begins.
Q: Will I need a second surgery to remove hardware?
A: Only if plates/screws cause discomfort (about 15-20% of cases). Many patients keep hardware permanently unless it interferes with activities or subsequent procedures.
Q: Can I run or play sports after healing?
A: Low-impact activities (swimming, cycling) are encouraged. High-impact sports may be discouraged depending on your joint health - your surgeon will provide personalized recommendations.
Q: How soon can I drive after surgery?
A: Typically 4-6 weeks for right leg procedures (longer if manual transmission), when you can brake forcefully without pain. Left leg procedures may allow driving sooner if using an automatic transmission.
Q: Is physical therapy absolutely necessary?
A: Yes - PT is crucial for restoring strength, range of motion, and proper movement patterns. Skipping therapy often leads to poorer outcomes and prolonged recovery.