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High Tibial Osteotomy (HTO) is a surgical procedure used to treat knee arthritis, especially when it's affecting only one side of the knee. It involves cutting and reshaping the upper part of the tibia (shinbone) to relieve pressure on the damaged area and shift weight to the healthier side of the knee joint.
When is High Tibial Osteotomy Needed?
Doctors usually recommend HTO for patients who:
- Are under 60 years old
- Have early-stage knee osteoarthritis
- Experience pain on one side of the knee, usually the inner (medial) side
- Want to delay a total knee replacement
- Are physically active and want to stay that way
What Are the Benefits of High Tibial Osteotomy?
Here's a quick look at the advantages of HTO surgery:
| Benefit | Explanation |
|---|---|
| Pain relief | Shifts body weight away from the damaged knee area |
| Improved knee function | Helps improve movement and mobility |
| Delay or avoid total knee replacement | Keeps your natural joint intact |
| Good for active lifestyles | Allows return to walking, sports, and daily activities |
Best Knee Osteotomy Surgeon
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Dr. (Prof) Anil Arora
Vice Chairman & Head of Department Orthopaedics & Joint Replacement Surgery, Max Super Speciality Hospital, Patparganj, Delhi Chairman & Chief Surgeon, Prof. Arora's Knee & Hip Surgery Clinics, NCR
Education & Training:
Hospital: Max Super Specialty Hospital
Clinic: Prof. Arora’s Knee & Hip Surgery Clinics, Delhi NCR
Experience: 33+ Years
- Commonwealth Academic Staff Fellowship in Primary, Complex & Revision Joint Replacement Surgery: Royal National Orthopaedic Hospital - Stanmore, London (UK)
- Professor at University College of Medical Sciences & GTB Hospital, New Delhi
- Assistant Professor at Dr SN Medical College & Mahatma Gandhi Hospital, Jodhpur
- Senior Resident at University College of Medical Sciences & GTB Hospital, New Delhi
Specialty: Orthopaedic Joint Replacement (Robotic Knee & Hip Replacement) Max Super Specialty Hospital
About: Prof. Arora, Guinness world record holder and Limca book of records holder, is a Senior Robotic Total Knee & Hip Replacement surgeon. He is an Internationally known figure in Orthopedics and joint replacement. He has been performing joint replacements since 1988, experience of more than 33 years and 12,000 Knee & Hip Replacement surgeries. Teaching in medical college and training Orthopedic surgeons has provided him with vast surgical and clinical experience and expertise. He has wide-ranging skills in knee and hip replacement surgeries. He is known for his sound clinical judgment and fine surgical skills. He was the first surgeon to start pinless computer navigated total knee replacements in north India. He is regularly performing primary, complex and revision (Robotic & pinless computer navigated) knee and hip replacement surgeries. He is also performing primary and revision elbow and shoulder replacements. He is the immediate past president of Delhi Orthopedic association.
How Does High Tibial Osteotomy Work?
Step-by-Step Overview:
- Diagnosis – Your doctor performs physical exams, X-rays, and MRI scans.
- Planning – Imaging helps determine how much realignment is needed.
- Surgery – A wedge of bone is either added (opening wedge) or removed (closing wedge) from the tibia.
- Fixation – Plates and screws are used to hold the bone in place.
- Recovery – Healing takes a few months with physiotherapy and lifestyle changes.
Types of High Tibial Osteotomy
| Type | Description |
|---|---|
|
Opening Wedge HTO |
A cut is made in the bone, and a wedge is opened to shift the knee joint. |
|
Closing Wedge HTO |
A wedge of bone is removed, and the bone is brought together to realign. |
What is Recovery Like After HTO Surgery?
Recovery from High Tibial Osteotomy typically takes 3 to 6 months. Here's what you can expect:
- First few days: Pain management and limited movement
- Week 2 to 6: Partial weight-bearing using crutches
- Week 6 to 12: Physical therapy begins
- After 3 months: Gradual return to normal activities
- After 6 months: Full recovery for most patients
Note: Recovery times may vary depending on age, activity level, and overall health.
Are There Any Risks Involved?
Like all surgeries, HTO comes with some potential risks, such as:
- Infection
- Blood clots
- Nerve or blood vessel damage
- Nonunion (bone doesn’t heal properly)
- Need for further surgery (like knee replacement)
Discuss these with your orthopedic surgeon before making a decision.
HTO vs Knee Replacement: What's the Difference?
| Factor | High Tibial Osteotomy | Total Knee Replacement |
|---|---|---|
|
Age group |
Under 60 |
Usually over 60 |
|
Joint preservation |
Preserves natural joint |
Replaces the joint |
|
Recovery time |
Longer initial recovery |
Shorter recovery in many cases |
|
Activity level |
Better for active individuals |
May limit high-impact activities |
Common Questions Patients Ask
1. Is High Tibial Osteotomy painful?
Yes, there is some pain after surgery, but it is manageable with medications and therapy.
2. How long does the plate stay in the leg?
The metal plate usually stays in permanently unless it causes irritation or complications.
3. Can you walk after HTO?
Yes, but weight-bearing is limited in the beginning. Most patients walk independently within 6-12 weeks.
4. Is HTO a permanent solution?
HTO can delay knee replacement by 5–10 years but is not always permanent.
Tips for Better Recovery
- Follow your doctor’s instructions strictly
- Attend physiotherapy sessions regularly
- Eat a healthy, calcium-rich diet
- Avoid high-impact sports initially
- Report any swelling, pain, or fever quickly
Final Thoughts:
High Tibial Osteotomy is a joint-preserving surgery ideal for younger, active individuals with knee pain on one side. It offers pain relief, improved mobility, and delays knee replacement. Talk to your orthopedic specialist to see if HTO is right for you.