High Tibial Osteotomy (Osteotomy of the Knee)

• What is a High Tibial Osteotomy?
• Why is an Osteotomy of the Knee Performed?
• How to Prepare for a High Tibial Osteotomy Surgery
• What Happens During a High Tibial Osteotomy?
• Are There Risks Associated with an Osteotomy of the Knee?
• Post High Tibial Osteotomy Surgery and Recovery

A high tibial osteotomy (HTO), or a knee osteotomy, is a surgical procedure that repositions the knee joint by adjusting the tibia, the large bone in the lower leg. This realignment helps alleviate the effects of early-stage osteoarthritis by relieving pressure on the damaged side of the knee joint. Cutting and reshaping either the tibia (shinbone) or femur (thighbone) aims to shift weight away from the compromised area, providing pain relief and improved function for arthritic knees.

HTO is a consideration for those experiencing knee misalignment, particularly when osteoarthritis has damaged parts of the knee joint. This procedure offers a way to delay or avoid more invasive treatments.

An osteotomy of the knee, particularly a high tibial osteotomy, is an alternative to knee replacement surgery. It's performed to address conditions where joint damage is significant but not beyond repair. This procedure is specifically intended for patients with knee pain from instability, limited mobility, or malalignment. Here are some reasons why this this type of osteotomy is performed:

• To realign the knee and alleviate pressure on the damaged side.
• To transfer weight from the arthritic part of the knee to a healthier area.
• To correct poor knee alignment.
• To prolong the lifespan of the knee joint.

An osteotomy shifts away the brunt of weight on damaged or worn tissue onto healthier, more stable tissue. This procedure is often considered for younger patients, providing a means to extend the time before knee replacement becomes necessary, potentially delaying surgery for several years. It can also be performed alongside other joint preservation procedures to facilitate the growth of cartilage repair tissue without excessive pressure.

Several days before an HTO procedure, you'll need to wash your knees multiple times daily with soap or Hibiclens solution to minimize infection risks. Avoid potential skin issues like scratches, cuts, sunburn, or poison ivy. You'll need to inform your doctor of any medications you're taking and may need to stop taking some, as directed by your physician, in the days ahead of the surgery.

The day before surgery, confirm the procedure time with your doctor. Do not eat or drink anything besides water after midnight the day before your appointment so you have an empty stomach, which is vital for anesthesia safety. If necessary, take approved prescribed medications with a sip of water early in the morning, and make sure you inform the anesthesiologist.

On the day of your HTO, bring any crutches, braces, ice machines, or imaging studies. Also, arrange a ride home after the procedure and coordinate proper home assistance during recovery.

A high tibial osteotomy is a straightforward procedure that adheres to the following steps:

1. Preparation: You will be administered general or spinal anesthesia. The physician will identify the surgical site and make an incision below the kneecap.
2. Alignment: Your physician will select either of the following methods based on your condition. Method one is to remove a wedge of bone from the tibia, correct the angle, and secure it. The second method is making a cut, spreading the bone apart, placing a graft, and securing it. With an oscillating saw, your physician will use guide wires to plan the size of the wedge and cut along it, either placing or removing the bone wedge.
3. Final Procedure: Your physician will insert metal plates and screws to hold the tibia and bones in place until the osteotomy heals. After the surgery, you will be taken to a recovery room and monitored until the anesthesia wears off. The surgery will take approximately 1-2 hours.

Risks from an osteotomy of the knee are relatively low, but just like any surgical procedures you must be aware of potential issues. Please discuss any questions or concerns you may have with your physician before your surgery. Risks associated with a high tibial osteotomy include:

• Infection near the insertion site.
• Blood clots.
• Stiffness of the knee joint.
• Damage to vessels and nerves.
• Failure of the osteotomy to heal, or delay in healing.
• Irritation from the implanted hardware.

Recovering from a knee osteotomy is a lengthy process, requiring several weeks on crutches and months of dedicated physical therapy. The initial follow-up visit is crucial to assess the osteotomy healing using X-ray images, and regular doctor check-ups are essential to monitor proper healing.

While patients typically regain unaided walking ability within 8 to 12 weeks post-surgery, a complete recovery may take six months to a year. The recovery duration hinges on various factors, including overall health, surgical complications, the type and placement of hardware, and the size and location of the bone wedge.

Patients typically go home after one or two days following the osteotomy. Your physician will prescribe you medication for pain, such as opioids, NSAIDs, or local anesthetics. You will also need to used crutches for several weeks following the procedure to avoid weight bearing on the operated knee. Your physician may also recommend wearing a knee brace or cast while the bone heals. It's very important that you begin physical therapy and perform the prescribed rehabilitation exercises to maintain knee range of motion and restore strength. If recovery goes as expected, you can resume regular activities 3 to 6 months after surgery.