High tibial osteotomy

High Tibial Osteotomy (HTO) is a surgical procedure aimed at relieving knee pain and improving function in patients with knee osteoarthritis primarily affecting the medial (inner) compartment of the knee. This procedure is often considered for younger, active individuals who wish to delay or avoid knee replacement surgery.

Indications

High Tibial Osteotomy is indicated for patients with:

• Isolated medial compartment osteoarthritis of the knee
• Varus deformity (inward angulation of the leg relative to the thigh)
• Symptoms not adequately controlled with conservative treatments such as physical therapy, medication, and injections

Procedure

The goal of the procedure is to shift the weight-bearing axis of the leg from the damaged medial compartment to the healthier lateral (outer) compartment of the knee. This is achieved by either removing or adding a wedge of bone in the tibia (shinbone) near the knee joint. The two main types of HTO are:

• Opening wedge osteotomy: Involves cutting the tibia and opening a gap, which is then filled with bone graft or a bone substitute to realign the knee.
• Closing wedge osteotomy: Involves removing a wedge of bone from the tibia to achieve the desired alignment.

After the bone is cut and the knee is realigned, the osteotomy is stabilized with plates and screws.

Recovery

Recovery from High Tibial Osteotomy involves:

• Initial non-weight bearing or partial weight-bearing on the operated leg, as advised by the surgeon
• Gradual increase in weight-bearing as healing progresses
• Participation in a physical therapy program to restore knee range of motion, strength, and function

Full recovery and return to high-impact activities may take 6 to 12 months.

Risks and Complications

As with any surgical procedure, High Tibial Osteotomy carries risks, including:

• Infection
• Blood clots
• Nerve or blood vessel damage
• Nonunion or delayed union of the osteotomy
• Overcorrection or undercorrection of the deformity
• Need for additional surgery

Outcomes

High Tibial Osteotomy has been shown to relieve pain, improve knee function, and potentially delay the need for knee replacement surgery in appropriately selected patients. However, the long-term success of the procedure depends on several factors, including the extent of osteoarthritis at the time of surgery, patient compliance with postoperative rehabilitation, and the patient's activity level.