High Tibial Osteotomy | PAX Medicus Medical Tourism UK

High Tibial Osteotomy (HTO)

High tibial osteotomy is a joint-preserving knee surgery used to correct leg alignment and shift body weight away from the damaged part of the knee. It can reduce pain, improve function and delay or prevent the need for total knee replacement in selected patients with varus (“bow-legged”) deformity.

Through partner orthopaedic centres abroad, Pax Medicus coordinates diagnostics, high tibial osteotomy surgery and tailored rehabilitation pathways for patients with early–moderate medial compartment osteoarthritis and malalignment.

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What Are Knee Degenerative Changes?

The knee is the largest joint in the human body and is exposed to substantial mechanical stress in everyday life. When the limb is aligned correctly, these forces are distributed evenly and the joint structures are protected.

If the alignment is disturbed, more load is placed on one side of the knee. In varus deformity (“bow-legged” position), the lower leg deviates inward relative to the thigh. This increases pressure on the medial (inner) compartment, especially the articular cartilage and medial meniscus, leading to joint degeneration and osteoarthritis.

  • Uneven load causes progressive cartilage damage.
  • Pain, stiffness and swelling gradually increase.
  • Everyday activities such as walking or climbing stairs become difficult.

Malalignment can result from congenital limb deformities, cartilage damage in childhood, trauma, metabolic diseases, bone tumours or metastases affecting the femur or tibia.

What Is Osteotomy?

Osteotomy is a surgical procedure in which the bone is cut, repositioned and stabilised to correct alignment and change how forces pass through a joint. In the knee, a high tibial osteotomy targets the upper part of the shinbone (tibia) to shift body weight away from the damaged medial compartment and onto healthier cartilage.

  • Realigns the leg to a more favourable mechanical axis.
  • Offloads the worn area of the joint.
  • Reduces pain during walking and activity.
  • Aims to delay or avoid total knee replacement.

When Is High Tibial Osteotomy Recommended?

High tibial osteotomy is mainly recommended for younger or middle-aged patients who have pain from medial compartment osteoarthritis and varus deformity, but who still have reasonably preserved cartilage elsewhere in the knee.

Typical candidates

  • Usually under 60 years of age.
  • Medial (inner) knee pain with varus alignment.
  • Active lifestyle, wishing to maintain own joint.
  • Good knee range of motion.

Goals of the procedure

  • Reduce pain and improve function.
  • Shift load from worn to healthier cartilage
  • Slow progression of osteoarthritis.
  • Postpone or prevent knee replacement.

Key selection factors

  • Severity and location of cartilage damage.
  • Degree of varus deformity.
  • Knock-knee (valgus) alignment.
  • Patient age and activity level.
  • Body weight – significant obesity is a concern.

High tibial osteotomy is generally not suitable for patients with advanced, multi-compartment osteoarthritis, severe joint stiffness or inflammatory arthritis affecting the entire knee.

Closing-Wedge vs Opening-Wedge Osteotomy

Closing-wedge osteotomy

  • Lateral incision above the tibial tuberosity.
  • A wedge of bone is removed from the tibia.
  • Bone ends are brought together and fixed with a plate.
  • Provides predictable, rapid bone healing
  • Slight shortening of the tibia is possible.

Opening-wedge osteotomy

  • Medial approach just below the joint line.
  • The tibia is cut and gradually opened to create a gap.
  • Allows fine-tuning of alignment during surgery.
  • Stabilised with a titanium plate and screws.
  • The gap may be left unfilled or packed with bone graft, often taken from the patient.

As with any surgery, high tibial osteotomy carries risks. Possible complications include over- or under-correction, delayed bone healing, infection and thrombosis. Following your surgeon’s instructions, including thromboprophylaxis, is essential to minimise these risks.

Qualification for HTO is based on a combination of symptoms, examination and imaging findings. The aim is to ensure that correcting the leg axis will effectively offload the damaged compartment and provide long-term benefit.

Assessment and investigations

  • Detailed medical history and pain assessment.
  • Examination of knee stability and range of motion.
  • Evaluation of walking pattern and limb alignment.
  • Standing, full-length X-ray to measure the mechanical axis of the leg.
  • Additional X-rays or MRI to assess cartilage and bone.

Contraindications

  • Advanced osteoarthritis involving the whole knee.
  • Severe joint functional impairment and contractures.
  • Rheumatoid arthritis or other inflammatory arthropathies.
  • Marked obesity or very poor bone quality.

The final decision is made by the orthopaedic surgeon, who determines whether realigning the limb axis will sufficiently unload the medial compartment and improve the patient’s symptoms.

As with other operations, you will have a pre-operative consultation with an anaesthetist, who will explain the safest type of anaesthesia for you. High tibial osteotomy is usually performed under:

  • Epidural (spinal) anaesthesia – numbness from the waist down.
  • General anaesthesia – you are fully asleep during surgery.

Pre-operative preparation

  • Prehabilitation exercises to strengthen leg muscles.
  • Stopping smoking and optimising body weight.
  • Review of medications and blood tests as required.
  • Instructions about fasting before surgery.

Why prehab matters

  • Improves muscle strength and joint control.
  • Enhances blood circulation in the limb.
  • Can shorten the rehabilitation period after surgery.
  • Helps you return more quickly to everyday activities.

The exact technique depends on your anatomy and the degree of correction required. The surgeon plans the correction angle using standing X-rays of the whole leg. During the operation, the tibia is cut and repositioned to achieve the desired alignment, then fixed with a plate and screws.

Key steps

  • Incision made just below the knee joint line.
  • Tibia carefully cut using specialised instruments.
  • Bone repositioned to change the load-bearing axis.
  • Stabilisation with a titanium plate and screws.
  • Wound closure and sterile dressing.

Types of HTO

  • Closing-wedge osteotomy – a wedge of bone is removed.
  • Opening-wedge osteotomy – a gap is opened and held apart.
  • The choice depends on anatomy, deformity and surgeon preference.

Recovery After High Tibial Osteotomy

Hospital stay is usually short. Many patients go home the same day or after one night in hospital, depending on their general condition and local protocol. Rehabilitation starts very early, often on the day of surgery.

Immediately after surgery

  • Leg elevation and cold packs to reduce swelling.
  • Pain relief and blood-thinning medication as prescribed.
  • Early physiotherapy to begin gentle movements.
  • Instruction on using crutches safely.

Weight-bearing and mobility

  • Crutches usually needed for around 6 weeks.
  • No or very limited weight on the operated leg for the first 3 weeks (as advised).
  • Gradual increase in weight-bearing as bone heals.
  • Regular X-rays to monitor bone healing and alignment.

Rehabilitation goals

  • Restore knee range of motion.
  • Strengthen quadriceps and hip muscles.
  • Improve balance and walking pattern.
  • Return safely to work, sport and daily activities.

Every rehabilitation plan is individual. Closely following the guidance of your surgeon and physiotherapist is crucial for a stable, well-aligned and pain-reduced knee.

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Disclaimer
*The Pax Medicus website provides information for guidance only and does not constitute medical advice, diagnosis, or treatment. Pax Medicus does not provide healthcare services and is not a substitute for consultation with a qualified medical professional. Always seek advice from your physician regarding any medical condition. Prices shown are indicative only and subject to confirmation by the healthcare provider. This is the official website of Pax Medicus; we do not operate through agents or third-party sites.

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