High Tibial Osteotomy

What is high tibial osteotomy?

A high tibial osteotomy  (HTO) involves cutting and reshaping the tibia to redirect weight away from the damaged area of knee joint. It enables correction of lower limb deformity and improved biomechanics.  during, and after the surgery, as well as information on the recovery period.

Indications and contraindications for high tibial osteotomy

High tibial osteotomy is effective for the treatment of:

Osteoarthritis: particularly for younger patients and where the arthritis disproportionately affects one side of the knee.

Malalignment: including the correction of varus (bow-legged) or valgus (knock-kneed) malalignment.

Contraindications for high tibial osteotomy include:

Inflammatory arthritis, including rheumatoid.

Severe osteoporosis or poor quality bone. 

Vascular insufficiency, including avascular necrosis. 

Active infection (local or general).  

Significant ligament damage.

Poor general health, including uncontrolled diabetes, severe heart disease or advanced lung disease. 

Benefits and complications of high tibial osteotomy

Benefits

  • Relief from painful symptoms, particularly during early-mid stage osteoarthritis.
  • Restoration of function and improved mobility.
  • Joint preservation.
  • Reduced joint stiffness. 
  • Alignment Correction.

     

Known complications

  • Permanent nerve damage resulting in sensory or motor deficits.
  • Superficial or deep infection.
  • Vascular injury and bleeding.
  • Pain. 
  • Deep Vein Thrombosis (DVT).
  • Over- or undercorrection.
  • Nonunion or delayed healing.
  • Migration of hardware.

The surgery

High tibial osteotomy (HTO) is a very specialised orthopaedic procedure. We routinely utilise 3D analysis and patient-specific instrumentation (PSI) in its practice. The accuracy of angular correction, and patient weight, are critical factors in the success of HTO.

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

 

On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general anaesthesia.
  • An incision (15-20cm) is made to expose the target section of knee joint. 
  • Specialised jigs are used to cut the bone.
  • The bone is realigned and secured with a plate. 
  • A bone graft may be added for additional support. 
  • X-rays are taken to confirm positioning.
  • The wound is sutured and dressed.
 

After your surgery

  • In-patient care: you will remain in hospital for three to five days for monitoring and early-stage rehabilition. 
  • Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms.
  • Mobilising: You may require a walker or crutches for six to twelve weeks after your surgery.
  • Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing. 
  • Physiotherapy: a tailored program of exercises will be provided to improve motion, mobility and muscle strength around the knee. 

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

This treatment could be eligible for our No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team. 

Speak with our team on +61 2 8882 9011

Need an urgent appointment? No problem.
Need X-rays? X-ray facilities available at all clinic locations

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Professor Munjed Al Muderis

Professor Dr Munjed Al Muderis is an orthopaedic surgeon specialising in osseointegration, hip, knee and trauma surgery. He is a clinical professor at Macquarie University and The Australian School Of Advanced Medicine, a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group.

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Disclaimer

Information provided via this website is for educational and communication purposes only. The material presented is neither intended to convey the only, nor necessarily the best, method or procedure, but rather represents techniques and procedures used by Professor Munjed Al Muderis. Professor Munjed Al Muderis disclaims any and all liability for injury and/or other damages which result from an individual using techniques presented on this website. Professor Munjed Al Muderis, to the best of his knowledge, believes the information presented is current and applicable to work being done by orthopaedic surgeons worldwide.