A high tibial osteotomy (HTO) is an operation to realign the leg by cutting and repositioning the top of the shinbone (tibia). It shifts weight away from the damaged part of the knee, relieving pain and delaying the need for knee replacement.
An incision is made below the inner side of the knee. A precise cut is made through the tibia, and the bone is gradually opened to the desired angle. A wedge of bone or bone substitute may be inserted. The new position is secured with a metal plate and screws. The operation takes approximately one to one and a half hours.
HTO is recommended for younger, active patients with arthritis affecting only one side (usually the inner compartment) of the knee, combined with bow-legged (varus) alignment. It is particularly suitable for patients who are too young or too active for knee replacement.
Physiotherapy, weight management, pain medication, bracing, injections, and activity modification. Partial or total knee replacement are surgical alternatives.
Full-leg X-rays and sometimes CT scan are required for precise planning. Standard pre-assessment. You will need crutches for several weeks.
The aim is to reduce pain by shifting load away from the arthritic compartment. This can delay the need for knee replacement by 10–15 years in many patients. Most patients report significant pain relief and improved function.
Knee stiffness is common initially and improves with physiotherapy.
Expected around the knee for several weeks.
The plate may be palpable under the skin.
The bone may be slow to heal or fail to heal. Smoking significantly increases this risk.
The alignment may not be exactly as planned.
Wound or deep infection.
The peroneal nerve is at risk, potentially causing foot drop. Rare with careful technique.
DVT despite preventive measures.
Extremely rare but serious condition requiring emergency surgery.
General or spinal anaesthesia.
Crutches for six to twelve weeks while the osteotomy heals. Weight-bearing is typically restricted initially. Physiotherapy begins early. Return to desk work at two to four weeks, manual work at three to six months. Return to sport at six to twelve months once the bone has fully healed. The plate is usually left in place but can be removed after healing.
Regular follow-up with X-rays at six weeks, three months, and six months to monitor bone healing. Physiotherapy throughout.
Possibly. HTO is designed to delay rather than prevent the need for knee replacement. Many patients do well for 10–15 years or more before considering replacement.
Knee replacements have a limited lifespan. In younger, active patients, HTO can delay replacement to a time when it is more likely to last the rest of the patient's life.
Yes, many patients return to running and impact sports, which is one of the key advantages of osteotomy over replacement.