Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Osteotomy


Related Terms

  • Bone Division
  • Bone Excision
  • Bone Incision
  • Bone Reshaping

Specialists

  • Occupational Therapist
  • Oral/Maxillofacial Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

Factors influencing duration will depend on the reason for the osteotomy, its location, the underlying condition, and the individual's age, mental health, and mobility status. The length of disability may also be affected by the number and severity of postoperative complications (e.g., wound infection, tissue or nerve damage, chronic pain, malunion or nonunion.).

Medical Codes

ICD-9-CM:
77.20 - Wedge Osteotomy, Unspecified Site
77.21 - Wedge Osteotomy, Scapula, Clavicle, and Thorac [Ribs and Sternum]
77.22 - Wedge Osteotomy, Humerus
77.23 - Wedge Osteotomy, Radius and Ulna
77.24 - Wedge Osteotomy, Carpals and Metacarpals
77.25 - Wedge Osteotomy, Femur
77.26 - Wedge Osteotomy, Patella
77.27 - Wedge Osteotomy, Tibia and Fibula
77.28 - Wedge Osteotomy, Tarsals and Metatarsals
77.29 - Wedge Osteotomy, Other: Pelvic Bones, Phalanges (of Foot) (Hand); Vertebrae
77.30 - Division of Bone, Other; Osteoarthrotomy, Unspecified Site
77.31 - Division of Bone, Other; Osteoarthrotomy, Scapula, Clavicle, and Thorac [Ribs and Sternum]
77.32 - Division of Bone, Other; Osteoarthrotomy, Humerus
77.33 - Division of Bone, Other; Osteoarthrotomy, Radius and Ulna
77.34 - Division of Bone, Other; Osteoarthrotomy, Carpals and Metacarpals
77.35 - Division of Bone, Other; Osteoarthrotomy, Femur
77.36 - Division of Bone, Other; Osteoarthrotomy, Patella
77.37 - Division of Bone, Other; Osteoarthrotomy, Tibia and Fibula
77.38 - Division of Bone, Other; Osteoarthrotomy, Tarsals and Metatarsals
77.39 - Division of Bone, Other; Osteoarthrotomy, Other: Pelvic Bones, Phalanges (of Foot) (Hand); Vertebrae

Overview

Osteotomy describes a variety of bone cutting procedures used to correct or reduce a deformity, craft cosmetic changes, or relieve arthritic pain. The deformity may have been caused by arthritis, trauma, or growth abnormalities (e.g., unequal leg length). Cutting through the bone(s) allows the ends to be repositioned in order to alter their shape or length, remodel their appearance, transfer points of stress, or reset fractures.

Osteotomy may be performed to repair an improperly healed fracture or to realign bones during hip or knee replacement. Typically, the surgeon chooses the proper angle, removes or inserts a wedge of bone, and then refashions or repositions the bones. The new bone ends are then joined and fixed in place to allow for healing.

Descriptive terms for the angle and amount of bone removal include the following: closing wedge, opening wedge, rotational, displacement, barrel vault, sliding oblique, horizontal, and vertical osteotomy. In a "shish kebab" osteotomy, multiple cuts are made in a long bone and the resulting segments are held in place with a bone pin.

Source: Medical Disability Advisor



Reason for Procedure

In general, osteotomy procedures are done to relieve pain, enhance appearance, correct or improve functional disfigurement, and to correct malunion, bone growth or bone shape abnormalities. Almost any bone can be repaired or repositioned by osteotomy including the hands, wrists, ankles, toes, shoulder blades, legs, arms, hips, jaws, vertebrae, and middle ear. Some examples of specific conditions treated by osteotomy are bunion repair, bowed legs (genu varus), arthritis due to poor bone alignment, shallow hip sockets (congenital hip dysplasia), chest-on-chin deformity caused by ankylosing spondylitis, various cosmetic and functional deformities of the upper and lower jaw, and repair of unequal leg length.

Source: Medical Disability Advisor



How Procedure is Performed

The surgeon adapts the various techniques to the clinical situation and radiographic findings, and may use one or more approaches during a single operation. The osteotomy location and angle of incision are determined using bony reference points, imaging studies, and the surgeon's experience. Computer assisted design (CAD) and interactive musculoskeletal software are increasingly used, especially in cosmetic procedures. These methods give an accurate 3-dimensional model that allows the physician to determine the best reference points, osteotomy angles, fixation methods, and probable outcome.

During surgery, inserted needles, guide pins, jigs, and templates may be used to help direct the surgeon along the correct incision line. Transverse osteotomy corrects problems of rotation by incising straight across the long axis of the bone (transversely) and then turning the bone until it is aligned. Opening wedge osteotomy may be used to correct a deformity. Here, the bone is cut transversely, then is tilted on the concave side (hinged up) and filled with spongy bone after it has been braced into its new position. Closing wedge osteotomy removes a triangular piece of bone from the rounded surface of a deformity; the gap is then closed and fixed in place. Oblique osteotomy may be used for several conditions including bone lengthening and bent or twisted deformities of the bone, such as clubfoot. In this case, the bone is cut obliquely and then adjusted to add length or repositioned.

Source: Medical Disability Advisor



Prognosis

The prognosis depends on the specific condition and procedure, the degree of deformity, surrounding tissue damage, age and health of the patient, amount of correction, and skill and experience of the surgeon. With osteotomies to repair painful hip dysplasia, more than 80% of individuals experience improved function and prevention of hip osteoarthritis upon 10-year follow-up (Troelsen). Ninety-one percent of individuals experience good-to-excellent outcomes 13 years after reconstructive tibial plateau opening wedge osteotomies (Kerkhoffs).

Source: Medical Disability Advisor



Rehabilitation

The primary focus of rehabilitation following an osteotomy is to restore full function to the involved joint and limb. The type of rehabilitation required will vary according to the body part involved, the preoperative functional status, and the underlying etiology. The most common sites for osteotomy are hip and knee joints.

The first goal of therapy is independent ambulation with an assistive device, such as a walker or crutches. Following an osteotomy, the individual is commonly restricted in weight bearing for up to 12 weeks. Ankle exercises should be encouraged to promote blood circulation and healing. For lower extremity osteotomy, anti-thrombolytic protocols should be in place and may include use of compression stockings, ankle exercises or pump, and medication. Edema and pain may be controlled with cold throughout the rehabilitation process (Noyres).

The next goal aims at restoring range of motion. Several weeks of restricted motion may be expected, depending on the involved joint. Braces are used to protect the joint and are part of treatment for 8 to 12 weeks (Noyres). Based on the protocol of the treating physician and with regard to surgical procedure and instrumentation, physical therapy will initiate exercise to the involved joint, beginning with gentle range of motion exercises and progressing to strengthening as tolerated. Early range of motion to include limited extension is frequently begun in the first 2 weeks, along with isometric strengthening exercises. The therapist must observe that the individual performs all exercises correctly to avoid harmful stress to the healing joint. Closed chain exercises may start around 3 to 4 weeks and heavier resistance begun at 7 to 8 weeks (Noyres). Full weight bearing usually does not occur until 8 to 12 weeks, and more extensive exercise such as walking, swimming, and elliptical or stair-climbing machines is not allowed until around 9 to 12 weeks (Noyres). Endurance and proprioceptive exercises should be added as strength increases.
As aerobic conditioning is an important component of recovery and general fitness, the therapist should instruct individuals to participate in low impact activities such as swimming, bicycling, and walking as appropriate. In addition, the therapist should inform the individual of the purpose of the osteotomy, of ways to protect the joint, and of the need for continued exercise after discharge from therapy. The individual may typically return to sports activities at 6 months, but return to vigorous sports may not be recommended for many individuals (De Lee).

An occupational therapy evaluation may be helpful to identify the need for adaptive equipment to allow for independent daily activities. An ergonomic assessment may be indicated if workplace tasks expose the individual to risk factors that compromise the integrity of the joint.

Additional information may provide insight into the rehabilitation needs of these individuals (Noyres).

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistOsteotomy
Physical or Occupational TherapistUp to 20 visits within 16 weeks
Note on Surgical Guidelines: The progression of rehabilitation may vary based on the underlying condition and joint involved. Some therapy may be initiated, a period of healing may be required and then the program progressed to higher level activities.
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Complications may include damage to surrounding muscles, nerves, and/or blood vessels. Joint contractures and complex regional pain syndrome (reflex sympathetic dystrophy) are also potential complications of osteotomy. Failure of the bone ends to heal and movement of the bone ends during healing may result in malunion or nonunion. Insufficient blood supply to the bone ends may cause delayed healing or death of the bone (aseptic necrosis). Potential for postsurgical infection, deep venous thrombosis, poor wound closure, and reaction to anesthesia are complications of any surgery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions will depend on the nature, location, and outcome of the surgery. Bone healing may take up to 12 months to complete and working conditions must accommodate recovery during that time. Individuals who perform heavy work may require temporary reassignment to a sedentary position. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

Kerkhoffs, G. M., et al. "Combined Intra-articular and Varus Opening Wedge Osteotomy for Lateral Decompression and Valgus Malunion of the Proximal Part of the Tibia. Surgical Technique." Journal of Bone and Joint Surgery 91 Suppl 2 Pt 1 (2009): 101-105. PubMed. <PMID: 19255203>.

Noyres, Frank R., et al., eds. "Section K: High Tibial Osteotomy in the Anterior Cruciate Ligament - Deficient Knee with Varus Angulation." DeLee and Drez's Orthopaedic Sports Medicine. 2 ed. Saunders Elsevier, 2003.

Troelsen, A., and K. Soballe. "Periacetabular Osteotomy and Hip Dysplasia in Young Adults (abstract)." Ugeskr Laeger 171 14 (2009): 1185-1189. PubMed. <PMID: 19338738>.

Source: Medical Disability Advisor






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