CPT® Code 27455

Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closure

An osteotomy of the proximal tibia is a surgical procedure that involves cutting and reshaping the upper part of the tibia, which is the larger bone in the lower leg. This procedure may also include the excision of a portion of the fibula, which is the smaller bone located alongside the tibia. The primary purpose of this surgery is to correct deformities of the knee, specifically genu varus, commonly known as bowleg, and genu valgus, referred to as knock-knee. The decision to perform this procedure is based on the specific type and location of the deformity, which can vary among patients. Various techniques can be employed during the osteotomy, including transverse, wedge, sliding, right or left angle, V-osteotomy, and Z-osteotomy, each chosen based on the individual case requirements. Prior to the surgery, the physician utilizes radiographic studies to determine the precise location and configuration of the bone cut necessary to achieve optimal alignment and correction of the deformity. The procedure is typically performed through an incision made over the lower leg, allowing for the careful dissection of soft tissues to expose the tibia and fibula. The tibial periosteum, a layer of tissue surrounding the bone, is elevated to facilitate access. The bone is then cut using specialized instruments such as drills, saws, or osteotomes, following the predetermined configuration. In some cases, a portion of the fibula may be excised or an osteotomy of the fibula may be performed concurrently. To ensure proper healing and alignment, bone grafts may be placed between the cut segments, and internal fixation devices, such as pins, screws, or plates, are applied as necessary. Alternatively, an external fixation device may be utilized. This procedure is specifically indicated for children or adolescents who have not yet reached epiphyseal closure, as it allows for continued growth and correction of the deformity.