High Tibial Osteotomy

What is High Tibial Osteotomy surgery?

High Tibial Osteotomy is a surgical procedure to correct the position of your leg and reduce the pain you have in your knee. There are a variety of approaches to carrying out this procedure and your surgeon will discuss the best option with you. One of the most common procedures carried out in this hospital is an oblique osteotomy on the inner side of the tibial (the bone beneath the knee). The bone is brought to adequate alignment and the gap formed in the bone is filled with bone grafts. This helps to position the bone and allow weight to pass through the outer, undamaged, part of the knee.

Why do I need High Tibial Osteotomy surgery?

Damage to the inner-knee can cause osteoarthritis. Such damage may be the result of

• a sporting injury

• rickets

• poliomyelitis

• direct trauma to the knee.

Osteoarthritis can be painful, limiting the function of your knee and quality of life.

The aims of High Tibial Osteotomy surgery are to

• correct poor alignment of the knee

• prolong the life of the knee joint, delaying the need for Total Knee Replacement surgery

• reduce pain

• improve function

• improve quality of life.

Alignment Correction in HTO (High Tibial Osteotomy)

When you draw a line from the hip joint to the ankle joint, normally it should pass through the centre of the knee joint. When there is cartilage injury on one side of the knee joint (most commonly the inner side of the knee) the knee joint starts to curve to the opposite side. This causes increased loading on the affected side and consequent faster progression of the joint problem. High tibial osteotomy (HTO) aims at realigning the limb to its normal alignment thereby shifting the weight on the bad cartilage of the affected side of the knee joint to good cartilage of the unaffected side. 

The persons who underwent this procedure report substantial pain relief and increase in activity levels. This is a procedure usually reserved for younger active individuals who are very young to be offered a knee replacement surgery. 

What can I expect after surgery?

The day of surgery

Once you are back on the ward the staff will continue to monitor your progress. You will be able to eat and drink on return to the ward. Some patients are able to get up with the physiotherapists later in the day; others stay in bed until the following morning.

The day after surgery and onwards

• You will be assisted out of the bed to sit in the chair, usually using a Zimmer Frame with the assistance of two members of staff. You will not be able to take any weight on your operated leg.

• You will have a wash and change your clothing.

• You will be visited by a member of the pain control team to ensure you are on adequate analgesia.

• You will be assessed by the physiotherapist to ensure you are walking safely, progressing from the Zimmer Frame onto elbow crutches; you will not be able to take any weight though your operated leg.

• The physiotherapist will also teach you some exercises.

• Arrangements for your discharge home will begin.

Physiotherapy and day-to-day care

All information provided here is for guidance only and is not exhaustive. Detailed, individualised instruction will be provided by the surgeon, physiotherapist and multi-disciplinary team.

Stairs technique

First take a step up with your healthy leg. Then take step up with your affected leg. Then bring your crutches up on the step. Always go one step at a time.

First put your crutch one step down. Then take a step with your affected leg. Then take a step down with your healthy leg, onto the same step as your affected leg. Always go one step at a time.

Physical therapy exercises

1. Quad sets.

Place a pillow under your knee. And press your leg down to press the pillow.  Hold for 10 seconds and repeat up to 20 times… This exercise can be done lying flat as shown.

  2.  Hamstring sets.

Lie on your back with knees bent and toes up. Dig your heels into the ground and press down. Hold for 10 seconds and repeat up to 20 times.

3.  Short arc exercises

Place a folded pillow under your knee. Straighten the bent knee and hold for 10 seconds. Repeat ten times.

  4.  Straight leg raise.

Tighten your thigh and pull your toes back, then slowly raise your leg 10 to 20 degrees. Slowly lower your leg., relax your muscles briefly, then repeat 20 times.