High tibial osteotomy

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An osteotomy meansbreaking and realigning the bone.  The tibia is the shin bone.  Ahigh tibial osteotomy is a surgical break in the tibia just below the kneejoint to change the alignment of the leg.  This procedure is used tocontrol the pain as a result of arthritis affecting the inner aspect of theknee in young patients.

Commonly arthritis inyoung patients affects the inner aspect of the knee and as a result the normalalignment of the knee changes leading to a bow legged appearance.  Due tothe bow leg deformity, there can be progressive worsening of the arthritis andpain felt on the inner aspect of the knee.  High tibial osteotomy (HTO) isused to relieve the pressure on the inner arthritic bearing of the knee and toredistribute the forces around the knee.

The alternative procedureto a high tibial osteotomy is a unicompartmental knee replacement, where theinner bearing of the knee is replaced with an artificial knee joint.

What happens during the knee operation?

During the surgery asmall wedge of bone is removed from the upper end of the shin bone and aftercorrecting the alignment the surgical break is held rigidly using a plate andscrews.   

What happens after the knee operation?

You are allowed to movethe knee straight away after the operation but you may need to restrict theamount of weight that you put through the leg until the surgical break healsup.  You also will need a brace for six weeks to protect the area of thebreak while it is healing up. 

What are the long term results of knee surgery?

This knee surgery is indicatedfor young people with arthritis of the knee and is often used as a stop gapoperation to delay joint replacement.  Various studies have shown that themajority of the pain can be relieved for up to 10 years but after that period aknee replacement is often required.  Performing a high tibial osteotomyavoids the risks of putting an artificial knee joint in a young patient whichmay need to be changed after 10-15 years.  The restrictions on theactivity following a high tibial osteotomy are also often less than thatfollowing a knee joint replacement.

What are the risks of a high tibial osteotomy?

The risks can includeinfection, deep vein thrombosis (a blood clot in the leg veins), delayedhealing at the site of the surgical break, under and over-correction of the bowleg deformity.