High tibial osteotomy is a surgical procedure where the bone of the upper tibia is cut and re-angled to change the limb alignment.

Page updated October 2023 by Dr Sheila Strover (Clinical Editor)

laminar spreaders opening the bone during high tibial osteotomy


Laminar spreaders open the wedge of a high tibial osteotomy.

high tibial osteotomy

The re-aligned bone is held in the new position with a plate and screws until new bone fills the gap.


Why would a surgeon propose changing your limb alignment?

The most common reasons for a surgeon to offer realignment surgery such as high tibial osteotomy include:

  • to take the pressure off one side of the knee if there is arthritis or a missing/very damaged meniscus on that side but the other side is in fairly good condition.
  • the person has arthritis in one knee compartment but is considered too young for a knee replacement.
  • the person has damage to the posterolateral corner and has continuing instability.
  • the person's occupation would make continuing work after knee replacement too challenging, eg builder.

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How long is recovery after a high tibial osteotomy?

Initially the patient will be non-weight-bearing on crutches for several weeks, progressing to partial weight bearing. Driving may be allow at 6 weeks. Full recovery may be a year or more.

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Limb alignment and pre-operative planning

The osteotomy surgeon will be meticulous in planning the exact amount of change of alignment required, and whether the adjustment requires an opening wedge or a closing wedge. For this, the patient will be ushered to the X-ray department and long leg X-rays will be taken, to include the pelvis and feet.

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Opening wedge high tibial osteotomy

Usually a high tibial osteotomy is performed to correct a varus (bow-legged) deformity, and the correction is made via an 'opening wedge'. Occasionally a closing wedge is indicated, and the site and degree of correction is nowadays determined by computer evaluation of weight-bearing full leg X-rays.

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What is a double osteotomy?

A double osteotomy or a double-level osteotomy is when the bone both above and below the knee joint are re-angled via osteotomy, ie a high tibial osteotomy below the joint and a distal femoral osteotomy above the joint.

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Forum discussions

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Peer-reviewed papers

  • High Tibial Osteotomy for Varus Deformity of the Knee

    Citation: Murray R, Winkler PW, Shaikh HS, Musahl V. High Tibial Osteotomy for Varus Deformity of the Knee. J Am Acad Orthop Surg Glob Res Rev. 2021 Jul 9;5(7):e21.00141. doi: 10.5435/JAAOSGlobal-D-21-00141. PMID: 34242204; PMCID: PMC8274793.

    "...valgus producing HTOs are primarily performed to unload the medial compartment. Further indications include chronic lateral/posterolateral ligamentous insufficiency or combined with cartilage restoration or meniscus preserving/replacing therapies."


    "Nonsmoking patients up to 60 years of age with a high preoperative activity level, a body mass index <30 kg/m2, mild to moderate osteoarthritis of the medial compartment defined as Kellgren and Lawrence grade 2 or less, and intact cartilage and meniscus in the lateral compartment are considered the ideal patients for valgus HTO."

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proximal tibial osteotomy

Dr Sheila StroverĀ (Editor)
BSc (Hons), MB BCh, MBA

See biography...


Relevant material -

Dr Sheila Strover2018 - Arthritis Flowchart - by Dr Sheila Strover (Clinical Editor)


Dr Sheila Strover2016 - Primer - High tibial osteotomy - by Dr Sheila Strover (Clinical Editor)


eBook - Knee arthritis interventions when you are too young for a total knee replacement

Written by Dr Sheila Strover (Clinical Editor)

Easy-to-read book about the various options for people with knee arthritis to try and prevent or delay knee replacement. Free to download.


List - Who's Who in Osteotomy for knee pain?

A useful list of world experts in knee osteotomy.