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Knee realignment (osteotomy) surgery
High tibial osteotomy (HTO), or knee realignment surgery, can be an effective alternative to knee replacement. This type of surgery can help reduce pain related to the early effects of osteoarthritis.
At HCA UK, you have
- Access to leading knee specialists
- Appointments confirmed within 24 hours of your initial enquiry
- Care that's rated ‘very good’ or ‘excellent’ by 97% of our orthopaedic patients'
What is a high tibial osteotomy?
The knee joint sits between the tibia (shin bone) and femur (thigh bone). A high tibial osteotomy is a surgical procedure where the tibia is cut and reshaped to alleviate pressure within the knee joint.
Using an X-ray of your leg as a guide, your surgeon will cut the bone either above or below the knee – the length and location of this cut will have been calculated in advance. This calculation also determines the kind of knee osteotomy you may have. Either a wedge of bone will be taken out and the gap closed up, or a gap will be created and bone will be inserted into the space. Metal plates and screws are then inserted to provide stability.
In some cases, a navigation-assisted osteotomy may be performed. This uses infra-red trackers to help map the shape of the knee joint and generate a computerised 3D model. This method allows a personalised approach to surgery. As well as assisting with the planning of the procedure, a navigation-assisted osteotomy provides an accurate way of monitoring complex interventions and therefore improving the precision of the surgery. Greater accuracy helps lower the chances of post-surgery complications, particularly in those with malalignment of the knee.
How do I know if I need a knee osteotomy?
A knee osteotomy can help people suffering from the early effects of osteoarthritis in the knee. It can also be used to treat knee malalignment, which you can be born with or develop due to trauma.
Osteoarthritis is one of the more common forms of arthritis. It typically occurs in the joints following long-term wear and tear, due to repetitive force sustained by the knee. It can result in tears to the menisci and articular cartilage, which can cause pain, clicking, locking and popping in the knee joint, as well as reduced mobility.
These injuries can also be sustained on one side of the knee due to malalignment. Uneven force can result in pressure on either side of the knee and cause repetitive damage.
These symptoms can interfere with daily activities and, in some cases, lower the quality of life.
Are there any non-surgical treatments for osteoarthritis or knee misalignment?
Your consultant will typically initially suggest non-surgical treatments such as pain management and physiotherapy. However, should these methods not sufficiently alleviate pain, swelling, tightness, weakness or locking of the joint which can lead to reduced mobility, then a high tibial knee osteotomy may be recommended. Your consultant will explain the method of surgery that will be used prior to your procedure.
This procedure is often used as an alternative to knee replacement surgery. In some cases, a knee osteotomy can extend the time before needing a full or partial knee replacement by up to 10 years.
What are the benefits of a knee osteotomy?
The main benefits of knee realignment surgery include:
- Relief from pain
- Delaying further wear in the knee joint
- Delaying the need for knee replacement surgery
- Correct misalignment of the knee joint
- Improving quality of life and allowing a return to regular activities
- The procedure relieves the pressure on the arthritic area of your knee and redistributes the weight through the joint evenly. This can help you return to physical activity without pain or restricted mobility. The benefits of a knee osteotomy usually last around eight to 10 years before further treatment or knee replacement surgery is needed.
What are the risks of having a high tibial osteotomy?
Knee osteotomy surgery is considered a safe procedure. However, general complications relating to any type of surgery can include:
- Blood clots
- Stroke
- Heart attack
- Pneumonia
A complication specific to high tibial osteotomy surgery is the possibility of 'non-union'. This is a condition where the bone does not properly heal together after the osteotomy. Other risks of a knee osteotomy include minor complications such as:
- Pain
- Stiffness and swelling of the area
- Ongoing osteoarthritis symptoms despite surgery
- Nerve or blood vessel injuries, rarely
If you require an operation, your consultant will discuss any potential complications with you in detail as part of your personalised care plan.
Knee osteotomy FAQs
The procedure normally takes around two hours to complete and is carried out under general anaesthetic, so you'll be asleep throughout.
As HTO surgery is carried out under general anaesthetic, you won’t feel any pain during the procedure. Our team is on hand to prescribe and manage any necessary pain medication during the post-operative period to ensure the best possible recovery.
Due to the nature of the surgery, you can expect to experience some degree of pain during the recovery period, depending on the severity of your symptoms prior to the operation. This will gradually improve in the days and weeks following surgery and you’ll be given appropriate pain medication to manage this.
Although the risks associated with a knee osteotomy are relatively low, it's still considered major surgery. You will be monitored closely during the procedure, with the team checking you regularly and ensuring your recovery starts well.
Before you have the operation, your consultant will talk you through the procedure and explain any possible risks and side effects. They’ll also answer any questions you may have.
Our dedicated orthopaedic nursing staff and anaesthetists work closely with the consultant and will advise on how long you should avoid eating and drinking before your general anaesthetic.
You'll have a 'standing long leg X-ray' before the knee osteotomy so your surgeon can calculate the exact position of the cut to your shinbone.
Most people can expect to be fully recovered in six months. Your consultant will let you know when you can return to your usual routine and invite you back for a check-up X-ray after six weeks. You won't have a plaster cast on when you wake up from surgery as the plates and screws will keep your knee stable. Your consultant will request a further X-ray of your leg to check the alignment and make sure the knee osteotomy has been successful.
The most important aspect of your initial recovery is to ensure the wound is kept covered, clean and dry to prevent any risk of infection. You won’t be able to bear any weight on the knee for the first few weeks but a member of our inhouse physiotherapy team will help you start moving as soon as possible following the procedure. They will also be able to give you advice on appropriate exercises to do at home.
If you're able to get out of bed and post surgery pain relief plans are in place, you should be able to leave the hospital the day after your operation. You should expect to use crutches during the initial stages of your recovery to avoid any weight bearing on the knee joint.
Why choose HCA UK?
- Specialist knee consultants: Our knee experts are leaders in their field and appointments are typically available within 48 hours
- Same-day imaging: Diagnostic imaging can often be carried out on the same day as your initial consultant appointment
- Leading treatment: We're the leading provider of private orthopaedic care in London because we treat the most cases, according to the Private Healthcare Information Network (PHIN)
- Trusted: Our 2022 patient satisfaction survey showed that 96% of patients would recommend our orthopaedic care to family and friends.
How much does a high tibial osteotomy cost?
The cost of your surgery depends on the specific treatment that’s recommended by your consultant. This will be discussed with you beforehand. We offer different options for paying for your private treatment including self-pay or through your medical insurance.
Find out more about our payment options.
Our Knee consultants
Mr Mazin Ibrahim
Orthopaedic Surgery
Mr Rob Pollock
Orthopaedic Surgery
Mr Jonathan Miles
Orthopaedic Surgery
Mr Richard Carrington
Orthopaedic Surgery
Request a knee appointment
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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.