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High Tibial Osteotomy or HTO

High Tibial (leg bone) Osteotomy or HTO and Distal Femoral (thigh bone) Osteotomy or DFO are the alignment correction procedures. These are valuable alternatives to Knee replacement in a selected group of patients. This is preferred approach in suitable patients for several reasons. As this does not lead to bone loss, at a later date even if the patient needs Knee replacement it will be primary knee replacement at that point of time. 


Osteoarthritis. Advanced medial compartment knee arthritis with severe pain and / or limitation of mobility. 

Severe Angular Deformity predisposing to uni-compartmental osteoarthritis.

Who is suitable for the HTO Surgery?


  • Young (40 to 60 Years of age) and active patient

  • Healthy otherwise

  • Non- obese patient

  • Persistent pain and disability affecting daily activities

  • Single compartment of the knee involvement

  • Compliant to follow post-operative protocols



Risks of HTO surgery are low however a small overall risk of adverse outcomes remains.

Fracture. During the surgery there is a small risk of fracture of the bone extending to the other side making the fragments unstable. However, the modern implants are strong enough to hold the bone fragments together and support well till the bone heals. 

Infection. Risk of infection is low with the advanced techniques and improvised theatre environment. Infection if picked up early, are likely to respond to antibiotics. In some instances it may need further washout or even removal of the implant.

Blood Vessel or Nerve Damage. Rare, but can lead to numbness or weakness down the leg. In most patients, that recovers within 3 months.

Clots in legs and lungs. To prevent clots (Deep vein thrombosis and pulmonary embolism), medications are given for first 14 days post-surgery.

Stiffness. Stiffness of the muscles is common post-surgery and needs good physiotherapy support.

Preparing for the surgery

A good control of medical conditions such as diabetes and blood pressure is required. In addition to that a thorough check up by the physician and advice regarding the dosage of the medications and any alterations to that the days before and after the surgery needs to be taken. Stopping smoking is necessary as smoking affects the healing of the surgical wound.

HTO Surgery

The surgery is either performed with injection in the back to numb the legs or alternatively under general anaesthesia where you are put to sleep for about the 1.5 hours of surgical time. Post-surgery you can expect to see a large dressing around your knee. The surgery involves making a cut in the bone either on the inner or outer side of the upper part of the leg bone (proximal tibia). Post that the bone is either opened up as a wedge or a wedge of bone is taken out and the rest of the bone is closed down (Open Wedge or Closed Wedge Osteotomy). Often a bone substitute or a bone graft is used to fill the gap. Then the bone is fixed with a plate and screws. This balances out the stress in the knee and hence relieves the pain in one compartment. 


Post-surgery you can expect rehabilitation to start early. On the day 1 Physiotherapists will ask you to move your ankles and press your knee down. On day 2, you can expect to sit on the edge of bed also take a few steps with the help of walker and the physiotherapist. A stay of 2 to 3 days in hospital is expected. You can expect to walk comfortably without a walker support by 2 to 3 weeks.

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