An opening-wedge osteotomy is a surgical procedure where a bone is cut partly through and wedged open, in order to re-angle the bone.

Page updated February 2024 by Dr Sheila Strover (Clinical Editor)

high tibial osteotomy
Opening-wedge osteotomy with plate.

 

When is opening wedge osteotomy surgery indicated?

Very often the early steps for developing knee arthritis, especially in people who have been very active, has been strain on one side of the knee from, for example, the earlier removal of the shock-absorbing knee meniscus. Initially the ligaments cope with the stress, but eventually the leg starts bowing out when bearing weight, and then the bowing may become permanent. That is when the damage triggers osteoarthritis on that side.

In selected patients, the progression of arthritis can be slowed if the forces are changed through the knee via an osteotomy.

  • Quote from peer-reviewed paper:

    "The objective of high tibial osteotomy (HTO) in patients with medial knee [osteoarthritis] associated with varus deformity is to transfer the weight-bearing load to the lateral compartment of the knee, thereby slowing the progression of the chondral pathology in the medial compartment....appropriate patient selection is crucial...."

    Citation: Pipino G, Indelli PF, Tigani D, Maffei G, Vaccarisi D. Opening-wedge high tibial osteotomy: a seven - to twelve-year study. Joints. 2016 Jun 13;4(1):6-11. doi: 10.11138/jts/2016.4.1.006. PMID: 27386441; PMCID: PMC4914376.

  • Quote from peer-reviewed paper:

    "The ideal candidate for an HTO is a middle aged patient (60 to 65 years of age), with isolated medial osteoarthritis, with good range of motion and without ligamentous instability."

    Citation: Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res. 2012 Jun;24(2):61-9. doi: 10.5792/ksrr.2012.24.2.61. Epub 2012 May 31. PMID: 22708105; PMCID: PMC3374001.

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How does the surgeon know how big to make the wedge?

The surgeon will carefully plan the procedure beforehand using long-leg planning X-rays.

  • Quote from peer-reviewed paper:

    "Multiple views should be obtained for preoperative radiographic assessment: bilateral weight-bearing anterior-posterior views in full extension, tunnel views with the knee in 30° of flexion, Rosenberg views with the knee in 45° of flexion, lateral views, and skyline views."

    Citation: Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res. 2012 Jun;24(2):61-9. doi: 10.5792/ksrr.2012.24.2.61. Epub 2012 May 31. PMID: 22708105; PMCID: PMC3374001.

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Is the plate removed after an osteotomy is healed?

It is possible to leave the plate and screws there forever, but they are usually removed once the bony union is strong. This avoids bony overgrowth around the plate which might make late removal difficult.

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Bone graft as an adjunct

Bone grafts may be packed into the opened space, to encourage faster healing of the bone across the new defect.

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Forum discussions

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Synonyms: 
HTO
OWHTO
high tibial osteotomy
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Dr Sheila Strover (Editor)
BSc (Hons), MB BCh, MBA

See biography...

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