What is a high tibial osteotomy?

High tibial osteotomy is a surgical procedure to realign the leg and reduce the pain you have from your knee by transferring the body weight to the preserved normal outer side of the knee.

This procedure does not return the knee to normal. Instead it prolongs the life of a damaged knee, helps relieve pain in the knee and delays the need for a total knee replacement.

When standing, your weight should be evenly distributed from your hip, through your knee to the centre of your ankle, to result in even contact with the ground. The diagrams below show this correct alignment (figure 1) and a malalignment (figure 2) from inner knee arthritis.

Why am I having a high tibial osteotomy?

You may be aware that your leg has become bowed. This will become worse as the weight is carried through the inner part of the knee and causes further damage. This may impair walking ability and result in pain in your knee even at rest. Many patients with this condition will proceed ultimately to total knee replacement.

Are there any alternatives?

Conservative options
A variety of non-surgical options are available to you:

• pain medication – Altering or increasing your pain medication. 
• use of a walking stick 
• use of a brace around the knee may help some patients. 
• do nothing at this time although this will gradually limit what you are able to do.

Surgical options

A variety of surgical options are available. These will be fully discussed with you by your consultant and the best option identified for you particular needs. This leaflet further explains the closing wedge osteotomy.

What happens during surgery?

A triangular wedge of bone is taken from the outer side of the tibia (the bone beneath the knee). This helps to realign the bone and helps your weight to pass through the outer undamaged part of the knee. The diagram below (figure 3) shows the basic idea of the surgery.

What can I expect following surgery?

• You will have a curved scar about 10cm long on the outside of your knee.
• The leg may be shorter by up to 1cm. This is unlikely to be noticeable.
• The surgery is not carried out to correct instability of the knee it is done to correct the alignment. There may, however be a secondary benefit, improvement in stability of the tibia (shinbone) against the femur (thighbone).

The following x-ray pictures show a malaligned knee (figure 4) and a knee following osteotomy (figure 5).

 What happens after the operation?

You will be in hospital for approximately 3-4 days following surgery. During this time you will:

• Need to keep your leg elevated to reduce swelling.
• Need antibiotics through a vein in your arm for 24 hours.
• Be helped by the physiotherapist to get up and move around with the aid of crutches.

You will be discharged once the physiotherapist and surgeon are happy that you are able to cope with using crutches. An outpatient appointment will be arranged approximately two weeks after your surgery.

How long will it take to heal?

You will probably need to use the crutches for up to two weeks following your surgery. At this point, the wound will be checked and the clips removed from the skin.

The physiotherapist will encourage you to move your knee and take your full weight on the affected leg. The surgeon may feel that it would be appropriate to place your knee in a brace to allow a certain range of movement. Again, you will be encouraged to bear your weight in order to help the bone to heal. Your progress will be checked by the surgeon using x-rays.

You should be aware that healing may take up to six months and it will take up to a year for you to feel the maximum benefit of the surgery.

Are there any risks or complications?

• General Anaesthetic – As with any surgery using a general anaesthetic there is a risk. This will be discussed with you prior to your operation by the consultant anaesthetist overseeing your care.
• Pain – After surgery, your pain should be controlled using medication. The anaesthetist may feel it is appropriate to anaesthetise your leg in the period following your surgery.
• Nerve and blood vessel damage – The surgery is carried out next to a number of nerves and blood vessels. Injury to these nerves or vessels occurs to less than one in 300 patients. Any damage identified at the time of surgery will be addressed before the wound is closed. We will ask for your consent before surgery to undertake any necessary further procedures.
• Swelling and numbness – Due to the nature of the surgery, there will be some swelling of the leg, which will go down in about two weeks. There will be an area of numbness next to the scar. You should be able to take your full weight on your leg but may require brace support for anything up to six weeks following surgery.

Contact numbers

If you have any concerns after you have been discharged, please do not hesitate to seek advice by contacting your GP.

You can also contact the ward (open 24 hours) or your surgeon’s secretary via the hospital switchboard on 0191 233 6161.