A procedure such as an osteotomy knee joint is one of the most sparing forms of surgical intervention in the structure of bone and cartilage tissue. The operation is performed by affecting the tibia or femur in order to reduce pressure on the knee joint. As a rule, it is carried out in the early stages of osteoarthritis and helps to reduce the severity of pain, restore normal mobility of the lower limb.

Indications and contraindications

Basically, corrective osteotomy is used to normalize the motor activity of a patient with deformation and degenerative-dystrophic changes in bone and cartilage tissue. The procedure itself is considered non-traumatic and bloodless, since an incision of no more than one centimeter is made for its implementation.

The main indications for the operation include degenerative changes in the cartilage, which provoke a violation of the axis of the lower limb. This pathological condition occurs due to injuries of soft tissues, ligaments and meniscus. Congenital anomalies of the limbs, the progression of gonarthrosis, and incompletely cured injuries of the knee joint are capable of provoking dystrophic disorders. Osteotomy is performed for disorders that develop against the background of rickets and bone tissue dystrophy.

With special care, osteotomy of the knee joint is performed in the presence of the following pathological conditions:

Preparation for the procedure

Preparatory measures begin with the diagnosis of the patient. The attending physician collects an anamnesis of complaints, a medical history and conducts an external examination of the joint. X-ray and MRI of the affected area are mandatory. Thanks to the data obtained, the orthopedist determines all structural changes in the joint cavity and draws up a plan for restorative measures after surgery. A week before the scheduled procedure, most medications are stopped. Alcohol and smoking are prohibited 14 days prior to knee osteotomy. People with injuries and erosions of the skin are not allowed to operate. In the presence of chronic diseases, it is important to bring them into remission before intervention.

How is it carried out?

Surgical intervention is carried out based on the individual characteristics of the patient's body and the degree of damage to the knee. There is a standard sequence of actions:

When performing an operation, the doctor takes into account the characteristics of the pathology of a single patient.

• An incision is made in the skin. After that, their edges are moved apart to the required indicators.
• An artificial graft or a previously prepared part of the patient's femur is inserted into the incision. All parameters are determined by computer calculations.
• A metal plate is placed to hold the bone fragment. For maximum fixation, knitting needles are used.
• The whole procedure is carried out under the control of an x-ray machine. This is necessary for making a fracture in the bone and correct insertion of the plate.

If the surgical intervention is carried out successfully, then the integrity of the patella is completely preserved and the patella tendons are not injured. At the same time, partial restoration of cartilage and a decrease in pain syndrome are noted, by normalizing the process of blood supply and eliminating congestion.

Osteotomy is a surgical operation used in cases where it is necessary to eliminate a defect in the bone tissue. Most often, the procedure is performed to restore the bone after its deformative damage.

Various segments can be operated on, including the bones of the legs and face. Osteotomy is possible only in a hospital, it is not done in clinics. Unfortunately, there is a risk of postoperative complications, especially if serious mistakes were made during the rehabilitation period.

The operation can be complex (in the treatment of large leg bones, for example) and simple (mini-osteotomy). The risk of postoperative complications is higher in case of complex technique.

1 What is an osteotomy: a general description of the operation

Nowadays, almost any problem associated with deformative lesions of bones and joints can be solved without problems. It is for the solution of such problems that osteotomy is used.

The procedure is designed to eliminate bone defects and the consequences of tissue deformation. With the help of the operation, it is possible to restore the functions of the musculoskeletal system, including by means of an artificial fracture.

A patient can deliberately break a limb at the level where the deformity is localized. This technique is often used for congenital or acquired pathologies (for example, an incorrectly fused fracture).

With its description and method of implementation, osteotomy can scare away most patients. In fact, everything is not as scary as it might seem: the patient does not feel anything during the operation (except for moderate discomfort associated with the work of receptors that fix mechanical stress).

The procedure has two types of conduction: through a small incision on the skin or by making several holes in the skin. This technique is used for both children and adult patients of different age groups.

1.1 What is carried out?

The procedure is applicable to the following groups of bones and joints:

• lower and upper jaw;
• pelvic bones, hip joints;
• lower leg bones, knee joint, metatarsal bone;
• elbow joints, bones of the upper extremities, including fingers and radius bones;
• it is possible to treat the femur (a rather complicated procedure that has risks of postoperative complications).

It is important to understand that each group of bones uses its own nuances of surgical intervention. In addition, different techniques can be used even for the same group of bones, but with different diseases.

For example, the femur can be treated using a corrective and restorative osteotomy method. The first option is suitable in cases where there is an incorrectly fused fracture. The second option is preferable for hip subluxation.

The final choice of technique remains with the attending physician. It is done after a series of diagnostic procedures.

1.2 Indications for carrying out

There are quite a lot of indications for osteotomy, because in addition to general diseases (which can affect different joints and bones), there are also specific ones that occur only in a particular group.

Osteotomy is performed for the following pathologies:

1. Incorrectly fused fracture of one or another group of bones (in this case, it is possible to carry out an artificial fracture with subsequent normal healing of the bone).
2. Ankylosis of a joint in a vicious position.
3. Coxarthrosis
4. Valgus deformity.
5. Consequences of rickets in the form of curvature (deformation) of the bones.
6. Traumatic deformities.
7. Shortening or pathological lengthening of the bone.
8. Dislocations and subluxations of bones or joints.
9. Birth defects and anomalies in the structure of certain bones.
10. Varus deformity.
11. False joint of the femoral neck.

Often, the operation is performed with various subspecies of arthritis (for example, with psoriatic arthritis). The fact is that arthritis can lead to deformities of the joint or bones. As a rule, this happens only in the most advanced cases, when the disease proceeds for a long time.

The specificity of the procedure is the treatment of deformative lesions as a result of injuries or complications of bones, but not joints. Treatment of complications of various types of arthritis is only an auxiliary function of osteotomy, which is not used constantly.

1.3 Contraindications

There are a fairly large number of contraindications to conduct. They cannot be ignored, because in this case the situation can be aggravated up to disability.

Osteotomy should not be performed in the following cases:

• during the period of acute onset or exacerbation of rheumatoid arthritis;
• third degree patellofemoral subspecies of arthrosis;
• obesity in a patient of 2-3 degrees (relative contraindication, in some cases ignored with the permission of the attending physician);
• the presence of osteoporosis;
• violations of the regenerative functions of the body, in particular - local (in terms of bone tissue regeneration);
• infectious pathologies of bone tissue (for example, syphilis or bone tuberculosis) - active or transferred in the recent past;
• arthrotic lesions (degenerative-dystrophic), localized in the collateral parts of the joints.

In addition, it is impossible to perform an operation with a general weakness of the patient, exhaustion, cachexia, fever (even with a minimally elevated temperature). The operation is also prohibited if a clear diagnosis is not established: for example, there are deformative lesions of the bone, but it is not known what caused them. First, a full diagnosis is made - then a decision is made on the operation.

2 Types of osteotomy

The operation has two types of conduct: closed and open way.

In a closed procedure, surgery is performed through a small (endoscopic) incision in the skin. The size of the incision usually does not exceed 2 centimeters. During a closed osteotomy, the doctor literally blindly crosses the bones using a special chisel. This is a difficult and dangerous technique, since the wrong actions of a specialist can lead to a number of serious complications.

Open osteotomy is used much more often, including because of the lower risk of serious complications. Here, the doctor does not work blindly: there is the possibility of a full visualization of the operated tissues. The incision on the skin for this technique is much larger, and is up to 12 centimeters in length.

Also osteotomy is divided into several subtypes:

1. Linear subtype (transverse or oblique). The diseased bone is incised in such a way that it is then aligned with the graft (plates). In dental implantology, intercortical osteotomy is performed to eliminate jaw defects.
2. Wedge-shaped subtype (akin, Akin). During the procedure, the patient is removed part of the bone tissue, due to which the remaining intact bone is subsequently aligned.
3. Z-shaped subtype. Used to treat hallux valgus deformity of the big toe. During the procedure, the doctor removes the overgrown tissue.
4. Angular subtype. Bone tissues are carefully cut at certain angles on both sides, due to which it is possible to put them in the required position.

3 How is the operation carried out?

There is no universal method for performing osteotomy: each case (disease) uses its own technique.

For example, during corrective surgery on the pelvic bones, the ilium is dissected in the area above the acetabulum. Next, the pelvic joint is displaced with the creation of an artificial "shield" over the articular head. The procedure is performed under endotracheal anesthesia (the safest option in this case).

Surgery of the knee joints is usually performed for the treatment of deforming arthrosis. Produce the intersection of the tibia, which leads to improved metabolism in the articular tissue by eliminating the stagnation of venous circulation.

The feet are usually treated for hallux valgus. To do this, the doctor makes an incision at the end of the bone adjacent to the big toe, followed by placing it closer to the inside of the foot. As a result, it is possible to eliminate the displacement, but sometimes it is necessary to remove part of the overgrown bone tissue.

Sometimes doctors go to some tricks when operating on non-specific cases of diseases. That is, right in the course of the operation, the standard tactics of actions can change. As a rule, this only has the best effect on the patient's recovery.

Whatever specific procedure is performed, there is always a non-zero chance of complications after the operation. Often, complications are caused by an incorrectly conducted rehabilitation stage.

3.1 Where is it held and how much does it cost?

Such complex surgical procedures are carried out only in large public hospitals or private clinics. It is advisable to contact specialized medical centers dealing exclusively with diseases of the musculoskeletal system.

The cost depends on the type of operation. For example, a corrective osteotomy costs around 50,000 rubles. The average cost of the procedure, regardless of its type, ranges from 60-65 thousand rubles.

3.2 Ligation after osteotomy (video)

3.3 Rehabilitation after osteotomy

Restoration of the function of the operated bone is at least 50% of the success of the entire treatment.

It is important to understand that in most cases, the bone will no longer be functionally the same as it was before the disease and surgery. However, such a restoration of the functionality is possible that there will not be much difference (according to sensations).

How exactly rehabilitation after osteotomy should be carried out depends on which particular method of operation was performed and on which area.

There are general rules:

1. In the first time after the procedure, complete rest of the area that was operated on is required. There should not be any load, even minimal.
2. Later, the patient is prescribed minimal physical activity to restore bone functionality. A dosed load triggers the acceleration of the regeneration of the operated tissues. The decision on when and how to load the operated part of the body should be made only by the attending physician.
3. Medical corsets, orthopedic insoles and other instruments can be used to reduce the load on the bones.
4. Medications (anti-inflammatory, regenerative) must be prescribed. Pain relievers and muscle relaxants may be used as needed.

Recovery after an osteotomy can take several months. It is very important to follow all the doctor's instructions: improper rehabilitation can not only ruin the effect of the treatment, but also make it worse than it was before the operation.

A knee osteotomy is used when you have early-stage osteoarthritis that has only damaged one side of the knee joint. By shifting weight away from the injured side of the joint, an osteotomy can ease and greatly improve function in your affected knee.

Osteoarthritis can develop when the bones of the knee and lower leg do not line up properly. This can place additional stress on either the inside (medial) or outside (lateral) side of the knee. Over time, this extra pressure can wear away the smooth cartilage that protects the bones, causing pain and friction in the knee.

(Left) Normal knee joint with healthy cartilage. (Right) Osteoarthritis that only damaged one side of the knee joint.

Advantages and disadvantages

Knee osteotomy has three goals:

• Transfer of weight from the affected part of the knee to the healthy area
• To correct knee alignment
• To prolong the life of the knee joint

By preserving its own knee anatomy, a successful osteotomy can delay the need for joint replacement for several years. Another advantage is that there are no restrictions on physical activity after osteotomy - you can comfortably take part in your favorite activities, even active physical exercises.

Osteotomy has disadvantages.

For example, pain is not as predictable after an osteotomy as compared to a partial or total knee replacement. Since you can't put your weight on your legs after an osteotomy, it takes longer to recover than a partial knee replacement.

In some cases, an osteotomy may make late surgical knee replacement more difficult.

Recovery from an osteotomy is generally more difficult than from a partial knee replacement due to the pain and inability to shift body weight to the leg.

Because the results of total knee replacement and partial knee replacement have been so successful, osteotomy of the knee has become much less common. However, it is not a bad option for many patients.

Procedure

In most cases, an osteotomy for an arthritic knee is done on the tibia (tibia) to correct the alignment, which puts a lot of emphasis on the inside of the knee.

(Left) This x-ray of a healthy knee shows a normal space between the tibia and femur. (Right) In this x-ray, osteoarthritis has damaged the inside of the knee. The tibia and femur rub against each other, causing pain (green arrow).

During this procedure, a wedge of bone is removed from the outside of the lower leg, under the healthy side of the knee. When the surgeon closes the wedge, he straightens the leg. This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the arthritic side. As a result, the knee can bear weight more evenly, which reduces pressure on the affected side.

In a tibial osteotomy, a wedge of bone is removed to straighten the leg.

Tibial osteotomy was first done in Europe in the late 1950s and came to the United States in the 1960s. This procedure is sometimes referred to as a “high tibial osteotomy.”

Femoral osteotomies are performed using the same technique. It is usually done to correct the alignment of the knee.

Candidates for knee osteotomy

Knee osteotomy is most effective for active patients with moderate weight who seek help in the age range of 40 to 60 years. Such candidates have pain on only one side of the knee, and no pain below the kneecap. Knee pain should be caused primarily by activity, and should also remain for a long period of time.

Candidates must be able to fully extend the knee and flex it to at least 90 degrees.

Patients with rheumatoid arthritis are not good candidates for osteotomy. Your orthopedic surgeon will help you determine if a knee osteotomy is right for you.

surgical procedure

Before the procedure

You will most likely be admitted to the hospital on the day of the operation.

Before the procedure, a doctor from the anesthesia department will assess your condition. He will review your medical history and should discuss the choice of anesthesia with you. Anesthesia can be either general (you are asleep) or injected into your back (you are awake, but your body is numb below the waist).

surgical procedure

Knee osteotomy surgery usually takes 1 to 2 hours.

Your surgeon will make an incision at the front of the knee, starting below the kneecap. He will plan the correct wedge size using the guide wires. Your surgeon will cut the bone along the guide wires and then remove the bone wedge. It will bring the bones together in order to fill in the space created by removing the wedge. The surgeon must anchor the plate into the bone until the leg heals.

This is the most commonly used osteotomy procedure called wedge closure.

After the wedge bone is removed, the tibia can be held in place with a plate and screws.

In some cases, instead of "closing" the bone, the wedge of the bone is "opened" and a bone graft is added to fill in the space and help correct the misalignment. This procedure is called wedge opening.

After operation

In most cases, patients stay in the hospital for 2 to 4 days after surgery. During this time, you will be monitored and given pain medication.

After surgery, your surgeon may put your knee in brace or cast for protection while the bone heals.

You may need to use crutches for a few weeks.

About 6 weeks after the operation, you should see the surgeon for a return visit. X-rays will be taken so your surgeon can check how well the leg has healed. After an observation, your surgeon will tell you when it is safe to stop using crutches and when you can begin full rehabilitation.

During rehabilitation, a physiotherapist will give you exercises to keep you active and rejuvenate.

You will be able to resume your full activities in 3 to 6 months.

Complications

As with any surgical intervention, there are risks associated with osteotomy. It is up to your surgeon to discuss each of the risks with you and take specific steps to help avoid possible complications.

Although the risks are low and the most common complications include:

• Infection
• blood clots
• Stiffness of the knee joint
• Vascular and nerve injuries
• The futility of osteotomy for healing

In some cases, a second operation may be required, especially if the osteotomy does not heal.

Conclusion

An osteotomy can relieve pain and slow the progression of arthritis in the knee. This may allow the patient to lead a more active lifestyle for many years. While many patients will eventually require a total knee replacement, an osteotomy can be an effective way to buy time until a replacement is needed.

About the author: Andrey Stepanovich

Bones take on an irregular shape and position if professional help has not been provided after the fracture. The essence of this procedure is that the diseased bone is broken and then fixed with the help of special plates or other devices so that it grows together and takes its natural shape. Osteotomy is used to achieve the following goals:

• return motor functions to the limbs, restore their performance;
• in the practice of plastic surgery, osteotomy is used to lengthen the limbs;
• restore the base function.

Depending on the purpose of the procedure, the object of osteotomy changes. Say, in order to return the support function, this procedure is performed on the hip joint.

Corrective osteotomy is aimed precisely at restoring the position, shape and performance of the limbs after an illness or injury.

The process of the procedure

Preparation

The process of preparation for this operation consists in an extensive radiograph, during which the orthopedic surgeon receives images of the area that can be corrected from different angles. Thus, he chooses the optimal tactics for conducting the operation.

Corrective osteotomy procedure

Those bone structures that are subject to correction are artificially broken by an orthopedic surgeon during the operation, and then fixed at the right angle and in the required position. In order for the bones to grow together correctly, a special plate or other special means, such as knitting needles and bolts, are installed. Thanks to modern technologies and in order to avoid complications in the form of contractures in adjacent joints, gypsum is not applied.

rehabilitation period

Rehabilitation lasts depending on which part of the body was operated on, for example, corrective osteotomy of the knee joint requires 12 weeks of rehabilitation. Moreover, the bones grow together for the first two months, the rest of the time they acquire the necessary strength. During this period of time, loads on the operated part of the body are excluded.

Indications

Corrective osteotomy is indicated for malunion of fractures. In addition, diseases such as:

• different types of arthrosis, including osteoarthritis and gonarthrosis;
• ankylosis of bones;
• rickets.

In addition, this operation is performed to delay the need to replace the joint with an artificial one, as well as to correct the prosthesis.

Contraindications

Osteotomy is contraindicated in diseases of the kidneys and liver, in disorders of the cardiovascular system. It can not be carried out if the patient has an exacerbation of any chronic disease, as well as in acute diseases. It is impossible to do an osteotomy for those who suffer from any diseases of a purulent nature.

Complications

This surgical operation is complex and quite risky. The following complications may occur:

• slow fusion of bones;
• the formation of suppuration;
• incorrect change in the position of the wreckage;
• the appearance of a false joint.

Prices and clinics

This operation is carried out only in well-equipped medical centers. For its implementation, specific experience of the doctor is required. Prices for corrective osteotomy depend on the nature and complexity of the operation.

Corrective osteotomy of the foot is a type of surgical intervention performed on deformed limbs. The essence of the operation is an artificial fracture of the bones to correct the defect.

Every third inhabitant of the planet suffers from articular syndrome. Rheumatoid arthritis, rheumatism, systemic lupus erythematosus, fractures, birth defects cause pathological changes in the joints. The problem is solved conservatively or surgically. Therapeutic tactics depend on the severity of the pathology, the duration of the process, the data of laboratory, instrumental research methods.

It is carried out on the tibia, ankle, knee, hip, shoulder joints. Quality operations stop the disease. The patient returns to normal life thanks to modern methods of treatment.

Osteotomy is an alternative to arthroplasty. It is carried out in adults and children.

The main indications for the technique:

1. The child suffers from congenital anomalies of the skeleton.
2. Incorrect union of the fracture, the formation of a false joint.
3. Deforming changes in the feet occur as a result of a severe disease of the bone tissue.
4. Ankylosis is manifested by a complete loss of joint movement. Surgical intervention helps restore the function of the damaged limb.
5. It is carried out with a hammer-shaped deformity of the fingers.
6. Severe forms of clubfoot. Poorly amenable to conservative treatment.
7. Indicated for flat feet.
8. With valgus deformity of the first finger, surgical intervention is resorted to.

Types and forms of the procedure

Osteotomy corrects deformity of the foot in various areas. The method of the procedure is determined by the severity of the condition, the pathological area, indications and contraindications for the technique.

There are the following types:

Z-shaped or scarf-osteotomy is performed in patients with hallux valgus. The deformity is manifested by an inward curvature of the limb. The disease affects mainly the distal parts of the legs. Pathology occurs in the area of ​​​​the thumbs. Physiotherapy, massage and scarf osteotomy allow you to get rid of foot valgus: restore the normal structure and function of the feet.

The technique has a number of advantages:

• corrects complex changes in the anterior part of the foot;
• allows for lateral displacement of bone fragments;
• well tolerated by patients;
• rarely accompanied by complications;
• the rehabilitation period is short (1-1.5 months);
• a scarf osteotomy can make the metatarsus shorter/longer if needed;
• the technique allows to reduce the load on the first phalanx. The surgeons move the fragments down. Does not affect limb function.

With valgus of the feet, a bump appears on the thumb. Provides discomfort and pain. Scarf osteotomy allows you to remove the growth. The doctor fixes the fragments with the help of special screws.

A wedge osteotomy is performed on the first toe. The main indications are the short first metatarsal bone, hallux valgus. The main stages of surgical intervention include:

• the surgeon makes an incision from the medial side of the first finger to the lateral;
• further shifts the phalanx inward;
• rotates the finger to a physiological position.

Osteotomy of the metatarsal bone is a simultaneous operation. It is used in combination with other surgical techniques to correct foot defects.

Angular allows you to give the correct position due to the bilateral excision of tissues. During the procedure, the surgeon cuts tissue at an angle from both sides. Bones become in a physiological position.

The linear form of the disease is divided into oblique and transverse. The essence of the operation is to align with a transplant.

Chevron osteotomy of the 1st metatarsal bone of the foot is used to treat valgus deformity of the first toe. The angle between the first and second phalanx is corrected.

The chevron shape has positive aspects:

• after the procedure, a long-term therapeutic effect is maintained;
• simplicity and safety of implementation;
• allows you to restore the lost functions of the limb in full.

The course of the operation includes the following steps:

1. The surgeon makes a Y-shaped incision in the joint capsule.
2. It releases the head of the metatarsus from the tendons. Carries out a V-shaped cut to fully release the head.
3. Then the doctor brings the metatarsal head out and fixes it with a screw. The rest of the bone is excised.
4. Restores the integrity of the joint capsule and sutures the wound.
5. The sutures are removed 5-7 days after the operation.

There are other ways to treat the foot (McBride, Sheda, Silver surgery, laser correction). The type of surgical intervention depends on the indications and localization of the pathology.

A qualified specialist will carry out the operation with high quality. There are two types of intervention:

• Closed - access is made through a small incision in the skin. The surgeon works blindly with a chisel. Requires high qualification, experience of the doctor. Wrong actions can result in damage to blood vessels and nerves.
• The open method allows you to fully visualize the damaged area through a large incision.

How is a corrective osteotomy performed?

Manipulation of the forefoot is carried out in a planned manner. Before the operation, a complete examination package is prescribed:

• A general analysis of blood and urine allows you to assess the state of the hematopoietic and renal systems. Intervention can be carried out in the absence of pathological changes in the analyzes.
• Blood sugar is tested to rule out diabetes. With high glucose levels, the procedure cannot be performed.
• A biochemical blood test allows you to evaluate the functions of the kidneys and liver, a coagulogram - blood clotting.
• Fluorography of the lungs, ECG are carried out without fail.
• To visualize the pathology, assess the degree of changes, the patient is sent for x-rays, computed tomography.

Corrective osteotomy on the forefoot is performed in several stages:

• The patient is given general/spinal anesthesia.
• The surgeon cuts the lateral surface of the foot.
• Performs bone spraying using one of the methods described above.
• Sets the joint of the first metatarsal bone in the correct position.
• Removes a bump.
• Fixes the first phalanx with screws or knitting needles.
• The surgeon restores the anatomical position of the ligaments and tendons.
• Next, sutures are applied to the skin.

After the operation, the patient is in the hospital for 3 days. Doctors monitor the patient's condition: temperature, blood pressure, pulse, respiratory rate, pulse oximetry. It is forbidden to load a sore leg. Wear hard-soled shoes for several months. Elastic bandaging of limbs is prescribed to prevent complications.

Make a control x-ray. It allows you to determine the degree of fusion, the overall dynamics. If there are no complications, doctors are allowed to give the leg a load. Over time, the patient can walk long distances, run, play sports.

Contraindications for surgery

Drug treatment of various deformities of the lower extremities is carried out for several months, years. Conservative therapy includes taking painkillers, vitamins, anti-inflammatory drugs. The patient goes to physiotherapy, massage, gymnastics. Methods are supplemented by wearing orthopedic devices: plaster casts, special splints, insoles, bandages.

Corrective osteotomy saves time and money. It takes several months after the operation, the patient begins to live fully.

Surgical treatment has a number of contraindications for performance:

• Acute period, severe course of rheumatoid arthritis.
• Active or past infectious diseases (syphilis, bone tuberculosis), their complications.
• Cardiovascular insufficiency stage 3.
• Oncological pathology.
• Respiratory failure of the last stage.
• Confirmed osteoporosis.
• Obesity is a relative contraindication. The operation is performed with the permission of the attending physician.
• Degenerative-dystrophic arthrosis, which is localized in the lateral parts of the joints.
• III stage of patellofemoral arthrosis.

Corrective osteotomy of the foot refers to surgical intervention on the lower extremities. It is carried out in order to restore the physiological functions of the joints.