High Tibial Osteotomy
80What is a High Tibial Osteotomy
A high tibial osteotomy seems like a medical tongue twister, intentionally complicated to confuse the average person. In fact, the title is a descriptive one, detailing the operation itself. In medical jargon, the suffix 'otomy' means 'to cut or incise' and 'osteo' refers to bone. An osteotomy is therefore the cutting of a bone. The location of the cut is also stated as the tibia is the shin bone in the lower leg.
Osteotomy is a surgical procedure designed to change the alignment of a specific bone. Osteotomies are performed all throughout the body, one of the more common being the operation that corrects severe bunions in feet.
Osteotomies can be used to correct unwanted angulation or rotation of the bone. In osteoarthritis, it is the angle that is important and the angle that needs correcting.
Indications for High Tibial Osteotomy
A High Tibial Osteotomy is used to treat unicompartmental osteoarthritis of the knee. Unicompartmental means the arthritis only affects one part of the knee. In this case, either the inside half, or outside half of the knee.
Once the smooth cartilage lining of the joint starts to wear away, the angle at the knee joint can begin to change. If the inside of the knee is being worn (the most common occurrence) the result is becoming "bow-legged". If the outside of the knee is being worn, the knee becomes "knock-kneed".
This slight change in angulation results in all of the body's weight being taken through the affected side. This results in dramatically increased wear on the already worn side, but good preservation of the unaffected side.
A High Tibial Osteotomy aims to realign the bones to restore even weight bearing between the inside and outside of the knee. It does not make the affected side "unworn", it just stops it from taking the overwhelming majority of the weight.
High Tibial Osteotomy - What is Involved?
There are two ways to perform a high tibial osteotomy, an opening wedge or a closing wedge.
An opening wedge cuts the bone, increases the angle and fixes it in its new position filling the gap with a bone graft.
A closing wedge osteotomy removes a wedge of bone to achieve the change of angle.
Either way an osteotomy is a major operation, effectively fracturing the main weight bearing bone of the lower leg and surgically fixing it afterwards.
The rehabilitation is lengthy and involves a prolonged period avoiding all weight bearing through the leg. Pain, stiffness and swelling are all experienced after the operation.
Having this surgery (for most people) requires a significant period off work and a major disruption to lifestyle. Mobility will be limited for 6 weeks and it will take 3 - 6 months to resume full activity.
Why Have A High Tibial Osteotomy?
A high tibial osteotomy is a time saving operation. It is generally performed on people too young to have a total knee replacement. Knee replacements wear out quickly when placed in young people so the osteotomy is performed to try and provide increased function and relieve pain until the person is old enough to have a total joint replacement.
It is important to note that an osteotomy does not address the wear on the affected side. It decreases the load on that half of the knee but it will remain worn and therefore cause some pain. This makes it somewhat different to a knee replacement that directly aims to relieve pain.
Should I Have A High Tibial Osteotomy?
This is a question that has many variables. The decision can only be made by you after discussing your particular medical history with an orthopedic surgeon who specializes in high tibial osteotomies.
Good candidates have a tolerance of pain, are active, not overweight and have a good understanding of why the procedure is being performed and therefore have appropriate expectations.
This operation is not for everyone but for many people it will let them delay a total knee replacement for many valuable years.
Want to know more?
- Unloader Knee Braces
A non-surgical option for the treatment of unicompartmental knee osteoarthritis. Worth considering prior to High Tibial Osteotomy surgery - High Tibial Osteotomy
For information on High Tibial Osteotomy, a common precursor to total knee replacement.
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I was scheduled for a high tibial osteotomy due to massive pain from genu varum (bow legged. pain in medial side of both knees. However medial cartillage in good condition. Pain due to pressure from bow leggedness.)
The surgeon started the surgery by doing a diagnostic arthroscopic surgery to check the condition of the lateral cartillage. He found the lateral cartillage contained chondromalacia damage and aborted the surgery.
I asked him, why can't he just make the tibia angle zero degrees. This would relieve the pressing due to the bowleggedness instead of loading everything on the lateral side (from varum to valgus (bow leg to knock knee) of the knee? He told me you can't do this. You must either load the weight on the medial or the lateral side.
Is this correct?
thanks a million.
I'm afraid so.
You need to have half of the knee in very good condition to have a HTO. This is because it will be asked to accept a greater proportion of body weight after the operation than it is currently doing. If the 'good' half of the knee is worn the surgery could make this half rapidly deteriorate and you would be worse off - having a significantly worn medial AND lateral compartment.
Unfortunately, you can't just set a knee to "zero degrees" without asking your other compartment to increase its load.
I had a HTO due to fact I was too young for a knee replacement. this is a very painfull op it took 18 months to fully recover with no pain. My knee is good now with no pain, Iam a lot more active now than before.
I'm scheduled for an HTO in a month from now (Sept 30/11). I hope they go through with it as I've been told in the past that I only had about 1/4 of the cartilage left on the lateral side. I'm hoping it's still intact so they can align the knee so my weight is loaded on the that side.
Also...I hear recovery is long and painful. I would appreciate any insights on recovery.
HELP!
i echo what Elizabeth said, very long and painful recovery time, but well worth it in the end. had it done on left leg in May 09 by a brilliant surgeonn, had the plate removed last Oct and was then thankfully painfree. had same op on right knee 13 wks ago and all looking good, obviously feel like i've gone backwards but very confident that it will work as well this time roud, you just need lots of patience.
What did you do for mobility and pain control. Have HTO scheduled for mid Feb. 2012 and 2 trips planned for June and Aug. Later trip includes golf. Think this plan is possible?
If you are lucky you might get around with a cart but I would suggest it is extremely unlikely you will be walking that far.
You will have to wait and see and hope for the best.
Good luck.
Just wondering about other peoples experience with HTO. I had a spiral fracture of my tibia about 10 years ago, ended up with a rod in my leg to put it back together. Had the rod removed and a follow up knee issues resulting in a knee scope and microfracture.
Now dealing with OA in the medial compartment due to a varus condition and doc wants to do a HTO. Been putting it off with an unloader brace for about 5 years now since I am only 44 but this brace, while it works, is a pain. Always chaffing and rubbing my leg raw. Anyone have any input on a comparison between the spiral fracture of a tib/fib and rod insertion and HTO? Any input would be helpful. Thanks.
Hi, great article!
My doctor uses the same technique (open wedge) described above.. I want to have the surgery for my bow legs. But apprently the surgery will make me knock kneed, is that true? Why can't I just have straight legs? I only have mild pain but I'm scared of developing arthritis in the future which is why I want my bow legs to be corrected. Any advice for me... ? :)
Due for an HTO on Thursday, March 1st. I am a 52 year old Triathlete. My surgeon says I could be back competing in maybe 6 months. Is this true? My surgeon does pro atheletes, so I know I have one of the best. He also says this will buy me at least 10 more years before a knee replacement. This sound mostly right?
This surgery scares the heck out of me. I have been told I have a high tolerence of pain, but I have had some abcessed teeth that might suggest otherwise.I am not looking forward to it. The schedular said for pain they give time-released morphine & suggest I do the Polar Care machine...all which helps with pain. Anyone have any comments of the previous mentioned treatments/medicine...and any other thing I can expect?
Had HTO. 6 weeks ago today. Let me first start by saying I have had 6 shoulder surgeries and thought that was the most painfull surgery. Let me tell you I was so wrong! First two weeks were a blur. Needed a lot of pain meds. I was non weight bearing for four weeks. Been doing some light hobbling around for two weeks. It's still painfull but can deal with it. I'm told 8 weeks is a turning point by my PT. feels like he's going to be right. Most of the numbness is gone now. I'm told I can gain 10 to 12 years on knee replacement. Have no regrets for the surgery just want to let you guys know what to expect.
Will be going for surgery the end of June. Doctor said I would be back to work in a few days. Is this correct?
My doc said all depends on your pain tolerence. Said most can expect 1 week to 10 days. I have mine scheduled for Thursday. I am shooting for the next Thursday to return to work, but we will see. Good thing for me is I am a teacher, so if I can stand it just 2 days, we will be on Spring Break the next week and I won't have to take a leave of Absence.
Sorry to say. If you are expecting to return to work in a week or ten days - that's not going to happen. I have a very high tolerance to pain and could only last maybe 1 or 1 1/2 hours sitting up. You will see that you need to spend a lot of tie on your back to keep the knee elevated. Keeping it elevated helps with the swelling and therefore the pain. I can't believe the DR said you would be able to work in a week or 10 days. I don't want to sugar coat anything here but it is extremely painful! Remember you are having your leg bone cut almost completely through with a bone saw. Not much different then having a traumatic fracture of the same bone, do you think you would be back to work in a week?
First of all IhadHTO, I appreciate your honesty. I have read all kinds of things with this surgery. From not that bad, if you take your meds, to people like you who say it's the worst they ever had. I choose the first one! I guess I'll just have to experience it for myself(not that I want to!) I also believe that I am in good hands. My faith is not in my doctor, but the one who made my doctor be able to do what he does...Jesus Christ my savior. I'll let you know next week. Maybe when we are both back to 100% again, if we can get back that far, we can link-up and go for a run!! I pray for your speedy recovery!!
Oh...and one last thing. Many people, atheletes have their leg broken everyday, without medication. And yes, they usually are back to school the next couple of days or so, so I think it is realistic to think that...but I will see. Thanks again!!
Day 3 after surgery. Was released about 30 hours after surgery. Did ok for awhile. Then took my pain meds & went into a depression. Shook that off now with God's grace & doing fine. I am gonna try not to take any more meds...especially the strong stuff. Sitting on computer now with virtually no pain...about 30-40 mins.
My surgeon said he has done about 150 of these. Only one guy took longer than 4 months to heal. Don't know how mine will turn out but again, I turn to my savior Jesus Christ!
Laurie I wish I could say your Dr is right, but I too thought I would be back at work in two weeks after having an HTO.Sorry but I took 6 weeks off from work. This surgery is VERY painful and you can not do anything. the first three weeks were the worst if your job has short term disability I highly reccommend you take advantage of it. Good luck
day 05 after HTO. Been out, sitting up all day, feeling great. I am really thinking it all depends on your surgeon. My biggest problem is sleeping, because I usually sleep on my stomach. I am going back to work on Thursday, 1 week after surgery. No reason not to. I pray Laurie that your surgery goes as well as mine has so far.
Day 11 after HTO. Went back to work 1 week after surgery. Got my stitches out on day 8. I'm allowed to let gravity bend my knee now. I'm about 45 degrees (1/2 way to normal)Scheduled for X-ray on 4 April..about 5 weeks after surgery.
Just praising God for virtually no pain, & no complicatios up to this point. Only problem I do have is my foot still swells up after being up most of the day..but was told that is normal.
I just hope & pray for anyone who has had, or will have this surgery!!
I had a tibial osteotomy in 1982 and have now developed an asymmetrical gait, can anyone direct me to any information which might indicate a direct correlation between the 2
Four weeks post HTO. Doing great, but ready to start walking without crutches. Been back to work 1 week after w/no problems. No pain at all. Once in awhile I do get a sharp pain where my plate is. I get my x-ray on Wednesday the 4th (about 5 weeks after). I believe the doc will allow me to start putting weight on it. I hope to be off crutches 2 weeks after that, Lord willing. He says I'll start rehab then and move into strength training. I believe I will be able to start swimming after I am full weight bearing. Then hopefully start biking a few weeks after that. My goal is running by June-July time frame and my first Sprint Triathlon by September.
Again, I thank my Lord & Savior Jesus Christ. I pray for all those going through this surgery.
I am 4 weeks post op from a hto on my left leg which I had because of severe arthritis. I saw my surgeon last Friday and he is happy with my progress.I not not seeing a physio as yet as my surgeon wants me to try to bend my knee myself. I am finding the recovery difficult andI am still in pain when I try to move my leg. My leg is still swollen and numb at the site of the hto although the incision on my knee is healing very well. I am finding it difficult to sleep due to leg pain and I am sure this is contributing to my depression. It is good to listen to the experiences of other people and I know it will be better in the long run.
it
I am 4.5 weeks post op now. I could not sleep due to cramps in left leg now I am so exhausted I am sleeping but when I wake in the morning my leg is so stiff and sore I am in agony. Has this happened to anyone else or should I consult my surgeon?
Bilby..Drink more water first of all. I know the first 2-3 weeks I didn't drink enough & I was cramping everywhere. For the pain, are you sleeping in your brace? My doc had me sleep in my brace for the first 5 weeks and my leg was fine. Now I have been working it out by myself (bending it) and sleeping w/out the brace & when I wake up, my leg is sore also. Nothing major, but when I sleep I guess I am doing something to it to make it throb. When I wake up and start my day it's ok...even when I am working on it there is no pain. In the morning I am easily bending it 90 degrees w/ no pain. At the end of the day I can get to 90 but w/some discomfort. I still am non-weight bearing which is driving me up a wall, but hopefully he will allow me to start in 2 more weeks...8 weeks post-op.
Good Luck & God Bless!!
Well, I had my closing wedge HTO about 6 1/2 weeks ago. I must admit I was not looking forward to this surgery. All in all, while no vacation, it was not as bad as I had feared. Had surgery on a Thursday morning and went home the next morning. If I had it to do over I might have tried to stay in the hospital at least for the rest of Friday to have better pain management but once settled in my trusty recliner I was alright. Had my staples out on day 7 (what a difference that made, those things are very uncomfortable)went back to docs around week 6 and xrays looked good so he let me start partial weight bearing (probably helped with it being a closing wedge and the internal metal plate they put in with 5 screws) and can . Also, I am allowed to do some stationary bike with no resistance which actually feels pretty good. One thing he allowed me to do leading up to week 6 was work on range of motion stuff and that helped a lot too. Now working on getting the muscles back in shape and slowly building up stamina. I am able to make due with one crutch now except for longer walks like from the parking garage to my office at work when I use 2 (mainly for balance and fear of tripping over something) I won’t really know if it was worth it until I am recovered enough to at least walk normally but I am hoping this does the trick. A few tips I would give is to try an unloader brace first. If that helps then you will supposedly have a good idea how the osteotomy will work for you. Drink lots of water, take fiber or stool softener daily (pain meds clog you up pretty good) and wean yourself off of meds instead of going cold turkey and don’t take the meds any longer than you have to. If you need them for pain then you need them for pain, just make sure to start weaning off as soon as you are able (only you can tell when that you no longer need them). They affected my mood greatly after taking them for a few weeks so I weaned myself off of them completely by 4 ½ to 5 weeks. Good luck to all!
High Tibial Osteotomy Surgery
Description of a Tibial Osteotomy
hussainammer@yahoo.com 14 months ago
It is very good to know the HTO. Thanks.