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 open the wedge of a 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.
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.
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.
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.
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.
- High tibial osteotomy
A short discussion about noises in the plated knee.
- 22 days post op: High Tibial Osteotomy (open wedge)
Discussion about the first three weeks after an osteotomy.
- High Tibial Osteotomy and Tibial Plateau Leveling
An anxious patient wants to learn more before moving from the unloader brace to a high tibial osteotomy..
- LOA #2- what is the best thing to do post op
About rehab and regaining range of knee motion after HTO hardware removal.
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."