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High Tibial Osteotomy


High tibial osteotomy is a surgical procedure to relieve pressure on the damaged site of an arthritic knee joint. The procedure involves bone removal and realignment of the knee bones. In high tibial osteotomy a triangular wedge of bone is removed from the upper end of the tibia. It is commonly used to relieve pain when non-operative treatments have failed.

High tibial osteotomy is commonly recommended for patients under 55 years of age with a mobile knee. It has proven beneficial for the young and also middle aged patients who want to delay surgery for total knee replacement.


Osteoarthritis is a slowly progressive degenerative joint disease commonly seen in the middle aged and elderly. It is a disabling disease that affects millions of people around the world. It tends to affect commonly used joints such as the hands, spine, hips, and knees. Osteoarthritis usually occurs from breakdown of the cartilage due to mechanical stress or daily wear and tear. Being overweight and having a previous fracture, injury or deformity can all contribute to development of osteoarthritis. This disease affects the tissues or cartilage covering the ends of bones in a joint and leads to degeneration of the bones. The common symptoms of osteoarthritis include:

  • joint pain,
  • joint stiffness, particularly in the morning
  • swelling around the joint
  • grinding or cracking sounds during joint movement and
  • Functional deterioration of the joint.


The surgery is contraindicated in patients with:

  • inflammatory arthritis,
  • obese patients with BMI above 35,
  • presence of flexion contracture of 15 degrees or more,
  • knee flexion greater than 90 degrees, patellofemoral arthritis,
  • ligament instability or
  • Varus thrust during gait.


The goal of the surgery is to release the involved joint compartment by correcting the malalignment of the tibia and to maintain the joint line perpendicular to the mechanical axis of the leg.

There are two techniques involved opening wedge osteotomy and closing wedge osteotomy. The surgeon determines the choice of the technique based on the requirement of the patient.

Opening wedge osteotomy

In this procedure the surgeon makes an incision in front of the knee just below the knee cap to remove a small wedge of bone from the upper part of the tibia or shin bone on the medial or inner side. The surgeon determines the correct size of bone to be removed by using guide wires. With the help of an oscillating saw a wedge of bone is removed and the space is filled with bone graft to assist the osteotomy to heal. The realignment increases the angle of the knee and relieves the patient’s painful symptoms.

Closing wedge osteotomy

This is the most commonly used procedure when performing a high tibial osteotomy. In this procedure the surgeon makes an incision in front of the knee and removes a small wedge of bone from the upper part of the tibia on the lateral or outer side. This end of the tibia is then lowered to bring the bones together and fill the space. The surgeon uses plates and screws to bind the bones until the osteotomy heals. This procedure unloads the pressure of the joint and helps to transfer some of the weight to the outer part of the knee, where the cartilage is still intact.

Post-operative care

After osteotomy patients may require two to four days of hospitalization. Immediately after surgery a light compressive knee brace or splint may be used to protect the knee and pain medications are given to reduce pain or swelling. During this time patients are instructed to follow post-operative protocols for a successful outcome.

Post-operative instructions include the use of TED stockings to reduce the risk of clot formation, crutch walking and physical therapy. Physical therapy includes range of motion exercises and strengthening exercises to restore range of motion and improve muscle strength. Physical therapy may begin the day after surgery to help the patient to move in and out of bed and to learn to use crutches in a safe manner. Crutch walking involves using crutches without weight bearing on the operated leg immediately after the surgery to allow the bone to heal. After a few weeks, progression to partial weight bearing in the operated leg will be encouraged.


As with any surgery, patients undergoing High tibial osteotomy surgery are at risk for developing certain complications following the surgery. Common risks and complications of the surgery are pain, swelling, numbness or injury to the surrounding nerves or vessels, infection, compartment syndrome, deep vein thrombosis, loosening of instrumentation (plates and screws) and non-union of the bone.

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