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High Tibial Osteotomy (HTO)

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High Tibial Osteotomy (HTO) is an orthopaedic surgical procedure used to correct knee alignment and redistribute body weight across the knee joint. It is most commonly performed in patients with medial compartment osteoarthritis of the knee associated with varus (bow-leg) deformity.

The procedure involves cutting and reshaping the upper part of the tibia (shin bone) to shift the load from the damaged medial compartment to the healthier lateral compartment of the knee.

Indications

HTO is typically recommended for:

  • Medial compartment osteoarthritis
  • Varus knee deformity (bow-legged alignment)
  • Young or active patients (<60 years)
  • Early to moderate knee arthritis
  • Patients wishing to delay knee replacement
Principle
  • In varus alignment, excessive load passes through the medial compartment of the knee.
  • HTO realigns the mechanical axis of the lower limb so that weight shifts laterally, reducing pressure on the diseased area.
Types of High Tibial Osteotomy
  1. Medial Opening Wedge Osteotomy
    • Bone cut made on the medial side of tibia
    • Wedge is opened and fixed with a plate
    • Most commonly performed technique today.
  2. Lateral Closing Wedge Osteotomy
    • Bone wedge is removed from lateral tibia
    • Bone ends are closed and fixed.
Basic Surgical Steps
  • Incision over the proximal tibia.
  • Controlled bone cut (osteotomy) is made.
  • Bone wedge opened or closed to correct alignment.
  • Fixation with plate and screws.
  • Sometimes bone graft is used in opening wedge osteotomy.
Advantages
  • Preserves the natural knee joint
  • Delays total knee replacement
  • Allows return to sports and active lifestyle
  • Improves pain and function
Recovery
  • Hospital stay: 1–3 days
  • Partial weight bearing: 4–6 weeks
  • Full recovery: ~3–6 months with physiotherapy
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Possible Complications
  • Delayed bone healing
  • Infection
  • Nerve or vessel injury
  • Loss of correction
  • Hardware irritation
  • Orthobiologics
  • Joint Arthrocopy
  • Arthroscopic ACL Reconstruction
  • Arthroscopic Meniscal Repair
  • Arthroscopic Rotator Cuff Repair
  • High Tibial Osteotomy (HTO)
  • Total Knee Replacement (TKR)
  • Total Hip Replacement (THR)
  • Ilizarov Surgery
  • Bone Fracture and Trauma Surgery

Do you have questions? Contact Us

    HTO is particularly beneficial for younger, active patients with isolated medial compartment disease, helping maintain their native knee joint for many years before considering total knee replacement.