A high tibial osteotomy (HTO) is a surgical procedure that involves cutting the tibia bone to realign it.
This procedure aims to correct those deformities of the lower limbs, which arise around the knee and to restore or improve the lower limb’s biomechanics. One of the common applications of osteotomies is to alleviate pain associated with partial joint degeneration and pain.
The main objective is to shift the patient’s body weight away from the damaged area and onto the healthier side of the knee, where the cartilage is still healthy. reducing discomfort and enhancing joint function.
Please find below more detailed information on the high tibial osteotomy procedure, including what to expect before, during, and after the surgery, as well as information on the recovery period.
The decision to undergo high tibial osteotomy should be made after a thorough evaluation by a healthcare professional, considering the individual patient’s specific medical history, condition, and overall health.
Patients considering high tibial osteotomy should discuss the potential benefits and risks with their healthcare provider. The decision to undergo the procedure should be based on individual medical history, condition, and the expertise of the surgical team.
High tibial osteotomy (HTO) is a very specialised orthopaedic procedure. It aims to correct various types of deformities around the knee joint. This is done to improve the longevity of the native knee joint in cases of severe deformity, partial damage of the joint cartilage in the knee or damage of other structures in the knee, for example, medial meniscus. The adjustment is most commonly used to reduce pressure on the damaged or arthritic side of the knee, thereby relieving pain and improving joint function.
HTO is a common procedure in our practice, and we routinely employ a 3D analysis and patient-specific instrumentation in this surgery, to ensure a perfect correction of the knee deformity is obtained.
HTO is a valuable option for a group of patients seeking an improvement in pain and function when the joint damage is not severe enough for considering an artificial joint replacement.
Anaesthesia and Infection Prevention: In the operating room, the patient is administered a general anaesthetic for comfort, and antibiotics are given intravenously to prevent infection.
A 15-20cm incision is made on the outside of the knee where the tibia will be cut.
We use virtual surgical planning and patient-specific cutting jigs for perfect cuts.
After the bone is cut, it is gradually corrected and secured with a plate. A bone graft (bone harvested from the patient or bone bank) may be added for support.
A final X-ray is taken to confirm the position, correction, and alignment of the limb.
The surgical wound is then closed and dressing is applied.
This surgery typically takes between 60 and 90 minutes.
Following tibial osteotomy surgery, patients can expect to spend three to five days in the hospital for recovery.
A physiotherapist will help you with your mobility.
Depending on the surgeon’s decision, some patients may need to use crutches for six to twelve weeks.
Post-surgery physiotherapy will focus on regaining motion in the knee, improving mobility, and strengthening the muscles around the knee joint.
Discharge criteria: Patients will be discharged once they can mobilise safely, have regained appropriate motion in the knee, and have their pain well controlled with medication.
During the first week after surgery, the leg may be swollen, and the knee may feel somewhat stiff. It is normal to require regular pain medication during this period. Patients are advised to diligently perform the prescribed exercises at home to optimise recovery following surgery.
The osteotomy is expected to heal over three months.
Follow-Up: Regular follow-up appointments with the team will help monitor your progress and address any concerns:
A consistent commitment to the prescribed physiotherapy exercises significantly influences recovery after tibial osteotomy surgery.
Patients should be aware that the leg may look different after the surgery. Besides a scar, the alignment of the knee may change significantly, typically from a bowed leg to a knocked-knee appearance. The return to manual work generally takes about three to six months, while sedentary or office duties can be performed about two weeks after surgery.
Factors for success: The success of a tibial osteotomy depends on two crucial factors: the patient’s weight and the accuracy of the angular correction during the surgery. When both factors are ideal, approximately 70% of patients may not require major surgery for the next 10 years.
Potential complications: As with any surgical procedure, there are potential complications associated with osteotomy surgery, including wound problems, infection, delayed or incomplete bone healing, injury to major nerves and blood vessels, compartment syndrome, irritation from metalwork, and fracture into the knee joint. However, the incidence of complications is generally low. Moreover, potential complications following osteotomy surgery are typically lower and more manageable compared to those associated with joint replacement surgery.
If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.
Norwest Private Hospital: (02) 8882 8882
Macquarie University Hospital: (02) 9812 3000