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High Tibial Osteotomy(HTO) is a specialised surgical procedure used to relieve chronic knee pain and improve joint function, especially in people with osteoarthritis affecting only one side of the knee, typically the inner (medial) compartment. The goal is to realign the knee and shift weight-bearing away from the damaged area, helping to reduce discomfort and delay the need for total knee replacement.

During the surgery, the upper part of the tibia (shinbone) is carefully cut and repositioned. This may involve creating a small wedge-shaped opening (opening-wedge osteotomy) or removing a wedge of bone (closing-wedge osteotomy), depending on the alignment correction needed. The adjusted bone is then secured with metal plates and screws to maintain stability as it heals.

After the procedure, patients usually wear a brace and may use crutches to avoid putting weight on the leg initially. As healing progresses, a structured physiotherapy program begins to restore strength, flexibility, and range of motion in the knee. With consistent rehab and follow-up care, many patients experience pain relief and an improved ability to walk, exercise, and perform everyday activities.

High tibial osteotomy (HTO) is performed to treat early-stage knee osteoarthritis, particularly when the damage is limited to one side (usually the inner/medial side) of the knee. In patients with a misaligned knee joint (bow-legged deformity), excessive pressure on one side accelerates cartilage wear. HTO involves cutting and realigning the tibia (shinbone) to shift body weight away from the damaged area to the healthier part of the knee joint.This joint-preserving surgery delays or avoids the need for total knee replacement, especially in younger, active individuals.

Consult an orthopaedic surgeon if you experience:

Chronic knee pain localised to the inner or outer side
Pain aggravated by standing, walking, or physical activity
Stiffness and reduced range of motion
Difficulty with climbing stairs or standing for long periods
Visible bow-legged or knock-knee deformity

HTO is often recommended when non-surgical treatments (medications, bracing, physiotherapy, injections) no longer provide relief.

Preoperative steps include:

Clinical examination and evaluation of walking pattern
X-rays and MRI scans to assess the extent of arthritis and joint alignment
Blood tests and anaesthesia clearance
Smoking cessation and weight management, if applicable
Detailed discussion about the procedure, rehabilitation, and expectations
Fasting for 6–8 hours before surgery

Patients are also advised to arrange for home mobility support after surgery.

There are two main surgical techniques:1. Opening Wedge Osteotomy:

A wedge-shaped cut is made on the inner side of the tibia.
The bone is carefully opened, and a metal plate is used to hold it in place.
Bone graft material may be added to fill the gap.

2. Closing Wedge Osteotomy:

A wedge of bone is removed from the outer side of the tibia.
The remaining bone is closed and fixed with plates and screws.

Surgeons select the approach based on the individual's anatomy and type of deformity. The procedure is typically performed under general or spinal anaesthesia.

The surgery typically takes 1.5 to 2.5 hours
Hospital stay is usually 2 to 4 days
Full recovery and return to sports or physically demanding activities may take 4 to 6 months, depending on the patient’s age, the rate of bone healing, and the intensity of rehabilitation.

Bleeding
Infection
Delayed or non-union of the bone
Nerve or blood vessel injury
Deep vein thrombosis (DVT)
Hardware-related irritation
Under- or over-correction of deformity

Pain relief and improved knee function
Realignment of the joint to reduce pressure on the damaged area
Preservation of the natural knee joint
Delay or avoidance of knee replacement surgery
Return to an active lifestyle for younger patients

Recovery after high tibial osteotomy involves using a brace and crutches in the initial days, with medications and ice to manage pain and swelling. From weeks 1 to 6, patients begin gradual weight-bearing and physiotherapy to regain motion. By weeks 6 to 12, focus shifts to strengthening and walking without support. Most individuals return to normal activities and low-impact sports within 3 to 6 months, depending on healing. Follow-up imaging ensures proper bone alignment, and in some cases, plate removal may be needed later for comfort.

High tibial osteotomy has a success rate of 80–90% in selected patients, especially those under 60 years of age with isolated compartmental arthritis. It offers long-lasting pain relief and functional improvement, with many patients avoiding or delaying knee replacement for 10 to 15 years or more.

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Process Involved for High Tibial Osteotomy

Treatment Stages for High Tibial Osteotomy are:-

Initial Evaluation : The process starts with a detailed knee examination. Your doctor will check how well your knee moves, how stable it is, and whether there’s pain during motion or weight-bearing. Imaging, like X-rays or MRI, may be ordered to assess the condition of your bones and cartilage. This step helps confirm if HTO is the right approach, mainly when damage is unevenly distributed across the knee joint.
Preoperative Preparation : Once HTO is considered appropriate, your medical team will walk you through essential preparations. This might include blood tests, cardiac evaluations, or stopping certain medications. You’ll also get detailed guidance on dietary changes, managing physical activity, and setting up your living space to make recovery safer and smoother.
Surgical Process : During the operation, the surgeon carefully reshapes the upper part of your shinbone (tibia) by creating a wedge to shift pressure away from the damaged area. This realignment allows the healthier part of your knee to bear more weight. A stabilising plate or implant is then used to secure the new position and encourage proper healing.
Immediate Post-Surgical Care : You’ll be closely monitored as your anaesthesia wears off after the surgery. Pain control, swelling management, and wound care are priorities during this stage. You might wear a knee brace and use crutches to avoid putting too much strain on your leg as healing begins.
Physical Rehabilitation : Recovery involves structured physiotherapy, often starting within a few days. With professional guidance, you’ll gradually begin movements that reduce stiffness and build muscle strength. Over time, your exercises will evolve to improve balance, flexibility, and confidence in walking and climbing stairs.
Ongoing Follow-Up and Recovery : Recovery doesn’t stop at the hospital. You’ll have scheduled appointments for imaging and clinical checks to ensure the bone is healing correctly. Based on your progress, your rehab plan may be fine-tuned. With time and consistent care, the goal is to help you return to your daily routine with less pain and better knee function.

The following conditions are treated in High Tibial Osteotomy:

Medial Compartment OA : HTO is often recommended when the inner portion of the knee joint becomes worn out due to arthritis. It helps reduce pressure on the damaged side by shifting the body weight to the healthier part of the knee.
Bowed Legs (Genu Varum) : When the legs curve outward at the knee, it puts extra strain on the inner side of the joint. HTO helps straighten the leg bones, creating better alignment and reducing joint stress.
Localised Cartilage Damage : HTO can benefit patients with cartilage wear limited to one part of the knee. Correcting the alignment slows further damage and helps preserve healthy joint surfaces.
Persistent Knee Pain Due to Poor Alignment : Some individuals experience chronic knee discomfort because of the localised body weight distribution. HTO addresses this by adjusting bone angles, which eases pain and improves movement.
Early Joint Degeneration in Active Individuals : For younger or physically active patients with early signs of joint damage, HTO helps delay or avoid needing a full knee replacement by protecting the natural joint for longer.
Post-Injury Joint Changes : Previous injuries, such as fractures or ligament damage, can lead to joint imbalance and discomfort. HTO helps restore proper alignment and relieve pressure caused by these changes.

Eligibility Assessment : This surgery is usually advised for people with knee pain caused by uneven wear, mainly when arthritis affects only one side of the knee joint.
Pre-Surgery Planning : Doctors will perform imaging tests and health evaluations. You'll also be given instructions on preparing for surgery and arranging support during recovery.
Surgical Procedure : A small wedge of bone is removed or added to the upper shinbone to shift pressure away from the damaged side of the knee.
Additional Corrections : During surgery, the doctor may smooth out rough cartilage or remove loose bone fragments to support better joint movement.
Closure and Immobilisation : After the correction, the incision is closed and covered. A knee brace or crutches may keep weight off the joint while it heals.
Post-Surgery Rehabilitation : Rehabilitation begins soon after surgery with light movements. Physical therapy is continued to restore strength, flexibility, and function over time.

Arthroscopy
Debridement
Synovectomy
Meniscectomy
Osteoplasty
Chondroplasty
Ligamentoplasty
Microfracture

Benefits of High Tibial Osteotomy include:

Alleviates Knee Pain: Realigning the knee joint, HTO reduces stress on the damaged medial compartment, leading to significant pain relief for individuals with early-stage osteoarthritis.
Enhances Joint Function: The procedure improves knee stability and function, enabling patients to perform daily activities such as walking and climbing stairs more easily.
Improves Mobility: Correcting the knee's alignment enhances its range of motion, allowing for smoother and more comfortable movements.
Delays Need for Knee Replacement: HTO can postpone or even eliminate the necessity for total knee replacement by preserving the patient's natural joint structure.
Reduces Inflammation: The surgery helps lessen inflammation and swelling associated with osteoarthritis by decreasing abnormal pressure on the knee joint.
Supports Active Lifestyles: HTO is particularly beneficial for younger, active individuals, allowing them to maintain their preferred level of physical activity without the limitations imposed by joint pain.
Promotes Joint Preservation: As a joint-sparing procedure, HTO focuses on retaining the knee's natural anatomy, which is advantageous for long-term joint health.

The following are the treating team members for High Tibial Osteotomy:

Orthopaedist
Radiologist
Anesthesiologist
Physiotherapist
Nurse
Surgeon
Technician
Nutritionist

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