High Tibial Osteotomy (Re-Alignment)

What is a HTO?

A high tibial osteotomy is a surgical procedure that realigns the leg. For some patients who have early, isolated knee arthritis, this surgery can delay or prevent the need for a partial or total knee replacement by preserving damaged joint tissue. The main advantage is that once the bone heals, patients can get back to physical and manual labour.

How does it work?

Medial (inner) compartment arthritis is the commonest pattern of knee arthritis. If it’s caught early, this compartment can be offloaded (unloaded) by re-aligning the shin bone. A fracture is carefully created from the inner side of the shin bone below the knee. This is slowly opened up to create a triangular gap on the inner side of the shin bone. This has the effect of shifting the mechanical axis (your body weight) from the inner side of the knee to the middle/ outer part of the knee.

The gap is filled with a wedge that encourages bone healing and a strong plate is implanted to keep the whole thing stable whilst the bone heals.

What are the complications?

Complications include wound infection, blood clots (DVT), damage to nerve and vessels, stiffness, delayed or non-union of the bone cut, risk of needing future surgery (partial or total knee replacement)

What happens after the op?

You may be given a brace after the procedure, although the plate has been designed so that patients can weight bear as pain allows with crutches. Our physios will teach you how to use crutches and go up and down stairs with them before discharge. You will be given a supply of strong painkillers and an advice sheet. I will follow you up with x-rays until the bone has healed.