High Tibial Osteotomy

HTO is typically recommended for relatively young, active patients who have pain predominantly from medial compartment osteoarthritis of the knee. It’s most suitable for patients with minor deformities and those who are within their ideal body weight range. It’s also more successful in patients with a good range of knee motion and absence of inflammation in the knee joint (as seen in conditions like rheumatoid arthritis).

The surgery involves reshaping the tibia (shin bone) to reduce pressure on the damaged side of the knee. An incision is made at the inner part of the knee to expose the tibia. The tibia is cut across its width, and a wedge-shaped space is created. In some instances, a bone graft is then inserted into the space to realign the leg. The graft could be from a donor, from another part of your body, or synthetic. Metal plates and screws are then used to hold the bone in the corrected position while healing takes place.

Patients typically go home the same day from surgery. It often takes about six to eight weeks for the bone to heal, but it could be three to six months before you can fully return to your previous level of activity or sports. A return to heavy manual work or sports may take longer.

After surgery, you’ll spend time in a recovery room as the anesthesia wears off until you can go home in an hour or two. Pain can be managed with medications. You will have a knee brace and may require crutches to aid mobility. You can expect some degree of swelling and bruising, which will gradually improve.

Physical therapy is a crucial part of recovery. The initial goals are to control swelling and regain range of motion. As healing progresses, the focus will shift to strengthening exercises and gradually increasing weight-bearing activities under the guidance of your physical therapist.

All surgeries come with potential risks, including:

• Infection: This occurs in a small percentage of patients and can usually be treated with antibiotics. Antibiotics are given during surgery to minimize this risk.
• Blood clots: These are rare but can cause serious complications that can occur in the legs, or in severe cases travel to the lungs. You will be given an aspirin to take for 30 days after surgery to minimize this risk.
• Nerve injury: This is very rare but can cause numbness, tingling, or weakness.
• Nonunion or delayed union: This means the bone takes longer to heal, or doesn’t heal, which may require additional surgery.
• Changes in leg alignment: Over-correction or under-correction of the deformity could occur, which may impact the success of the surgery.

If left untreated, osteoarthritis can lead to increasing pain, instability, and decreasing function and mobility, which can significantly affect your quality of life. The damage to your knee joint could progress, and you might need more complex procedures in the future, such as total knee replacement.