High Tibial Osteotomy

A Tibial Osteotomy is an operation in which your tibia (shin bone) is surgically broken (this means that it is broken under the control of a surgeon), once broken the tibia can then be realigned into a better position. The purpose of this is to alter the way that forces cross the knee and takes pressures off of certain areas of the joint surface. Once healed, body weight is transmitted mainly through undamaged cartilage resulting in less pain and swelling for the patient.

This operation is sometimes carried out when knee arthritis is present in young and middle-aged patients. It is only effective if the arthritis is confined to ONE area of the knee, the rest of the joint must be health.

An osteotomy is usually only considered as a treatment option if things such as Physiotherapy and Anti-Inflammatory medication hasn’t helped with the patients symptoms.

A high tibial osteotomy (HTO) is usually performed when there is localised medial compartment osteoarthritis of the knee and mal-alignment (the medial or lateral side of the knee is loaded excessively). Sometimes it can be a difficult choice whether to perform a HTO or a medial unicompartmental knee replacement (UKR). HTO is a better option for younger patients (under 50 years of age) and those who are very active (particularly if you have a heavy manual profession).

The decision for HTO is made following a detailed discussion with your surgeon.

High tibial osteotomy - normal alignment High tibial osteotomy - mal alignment

Mal-alignment is seen on the right image. In a normal knee, a line drawn from the centre of the hip to the centre of the knee will go through the middle of the knee joint (left hand image). In mal-alignment (right) the line goes through one side of the knee joint (medial in this case) indicating that side of the knee is being loaded excessively. The principle of a HTO is to shift the load to the other side of the knee.

Surgery

An osteotomy is carried out under General Anaesthetic. An incision (approximately 15cm) is made over the upper part of the tibia. Using X-ray images as guidance, the bone is then cut ALMOST all the way across. This cut allows the surgeon to re-align the tibia. The bone is then held in it’s new place with a plate and screws

Pre and post op medial osteoarthritis

Pre- and post-op images showing medial osteoarthritis (left) and the correction held with plates and screws (right).

Measurements for high tibial osteotomy

Measurements are taken to decide how much to re-align the leg, the bones are then held with plates and screws.

Recovery

Patients are partially weight bearing for 6 weeks with crutches and then fully weight bearing after. Total recovery is 3 months.

Normally you will go home 2 days after this operation. To begin with you can partially weight bear on the leg, you will be allowed to progress to full weight bearing after 6 weeks as long as your X-Ray shows that the bone is healing. Once fully weight bearing you can stop using your crutches as soon as you have no discomfort.

Long-term

90% of patients have a good outcome at 5 years.

70-80% have a good outcome at 10 years.