High Tibial Osteotomy

When a High Tibial Osteotomy May Be Considered

High tibial osteotomy is typically considered for people with medial compartment arthritis or alignment patterns that place increased load on the inner side of the knee.

Medial Compartment Overload

If you have inner knee arthritis, even a small shift in alignment may help balance the load across the joint. This is often assessed with weight-bearing X-rays. Even a few degrees of correction can change where force travels during walking.

Knee Alignment That Contributes to Symptoms

Varus knee alignment, sometimes described as bow-legged alignment, may cause uneven distribution of force during walking and sports. Addressing the alignment may support more even loading of the joint over time.

Active Individuals Wanting to Maintain Kneeling or Running Tasks

Some people with bow-legged knee alignment prefer to preserve their own joints for as long as possible before considering total knee replacement. Maintaining higher-impact or pivoting activities may be a factor discussed during assessment. This approach may be helpful when the rest of the knee joint remains relatively healthy.

Relief From Non-Surgical Management Has Plateaued

Physiotherapy, activity modification, analgesics as advised by a GP, and targeted load management are usually trialled first. If symptoms persist, realignment may be explored. A high tibial osteotomy may also be considered when imaging shows preserved cartilage in compartments away from the area of wear.

Understanding the Goal of Realignment

High tibial osteotomy aims to shift the mechanical axis of the leg so the load passes through a healthier region of the knee.

Adjusting Load Pathways

A controlled cut is made in the upper tibia, then carefully repositioned to achieve the intended alignment correction. This mechanical shift can support improved comfort during walking and standing.

Protecting Healthier Joint Surfaces

By reducing stress on the worn area, the procedure may support more balanced knee mechanics during daily movement. This joint-preserving knee surgery may help you maintain mobility for a longer period without immediately proceeding to a joint replacement.

Preserving Native Ligaments and Joint Structures

The ACL, PCL, and menisci are maintained, which may support natural joint movement patterns. This preservation may be important for people who wish to continue activities that rely on ligament stability.

Preoperative Assessment and Planning

A clear understanding of your symptoms, knee structure, and movement demands guides decision-making. Good planning helps ensure that the degree of correction aligns with your functional goals and the condition of the joint.

Clinical Examination

Your surgeon assesses leg alignment, walking pattern, range of motion, ligament stability, and areas of tenderness. Subtle findings, including tracking patterns and point tenderness, can guide decision-making.

Imaging

X-ray examinations provide information on joint space, alignment, and bone quality. MRI may be considered if there are concerns about associated cartilage or meniscal injury. In some cases, long-leg alignment films are used to measure the exact degree of correction needed.

Discussion of Activity Requirements

Work demands, recreational activity, and personal goals help determine whether realignment is appropriate. Understanding your expectations early ensures a balanced discussion of benefits and limitations.

How High Tibial Osteotomy Is Performed

The procedure is planned precisely, using imaging and measurements to determine how much correction is needed.

Step One: Creating the Osteotomy

In a knee osteotomy procedure, a controlled opening (open-wedge) or closing (closed-wedge) cut is made in the upper tibia, depending on the technique chosen. Your surgeon selects the method based on bone shape, alignment, and your specific anatomy.

Step Two: Adjusting the Alignment

The tibia is shifted to the planned position to realign the leg axis. This knee alignment correction is checked throughout the procedure to ensure accuracy.

Step Three: Fixation

A plate and screws stabilise the osteotomy while the bone heals. Bone graft or bone substitute may be used in open-wedge procedures. Fixation choice depends on bone quality and the amount of correction required.

Step Four: Confirming Alignment

Intraoperative imaging verifies the correction before the wound is closed. Ensuring the axis is accurate is an essential part of successful realignment.

Recovery After High Tibial Osteotomy

Osteotomy recovery varies depending on the degree of correction, bone healing, and individual activity levels.

Initial Recovery Phase

You may need crutches for a period to protect the osteotomy. Swelling is common, and early physiotherapy supports gentle movement and quadriceps activation. Elevation and intermittent icing may help with early discomfort.

Progressive Weight-Bearing

Weight-bearing is gradually increased according to the healing progress shown on X-rays. Healing times differ, and your surgeon will confirm when it is safe to increase load.

Rehabilitation Goals

Rehabilitation typically focuses on strength, gait retraining, neuromuscular control, and mobility. Progression is structured to support safe bone healing while restoring knee function.

Return to Work and Sport

Timelines vary widely, depending on your work duties and activity goals. Moderate exercise may resume earlier than higher-impact activities. Any return to running or pivoting sports will be planned in conjunction with your physiotherapist.

Results may vary depending on individual circumstances. A personalised plan is developed with your surgeon and physiotherapist.

Long-Term Considerations

High tibial osteotomy may delay the need for knee replacement in some people by improving mechanical alignment, though this is not guaranteed. Your long-term outcome depends on many factors, including cartilage condition, activity level, and alignment maintenance.

Impact on Future Surgery

If a total knee replacement is needed later, most people can still undergo the procedure, although the prior osteotomy may influence planning. Surgeons consider hardware placement and bone shape during future assessments.

Activity Tolerance Over Time

Many individuals maintain or regain good function with appropriate rehabilitation, depending on the underlying condition of the joint. Balanced loading can support long-term joint health.

Monitoring Alignment and Healing

Regular follow-up ensures bone healing, alignment, and that symptoms are progressing as expected. Ongoing physiotherapy may help maintain leg strength during recovery.

When to Seek Review

A review with a knee specialist may be helpful if you notice:

• Persistent pain on one side of the knee
• Difficulty walking long distances
• Discomfort that worsens with load-bearing tasks
• Known varus alignment contributing to symptoms
• Uncertainty about whether realignment surgery may be appropriate

A knee orthopaedic surgeon in Sydney, such as Dr Jonathan Negus, can help determine whether high tibial osteotomy is a suitable option and discuss alternative approaches when required.

Next Steps

Choosing whether to proceed with realignment surgery can feel complex, especially if you are comparing different options such as non-surgical care, partial knee replacement, or total knee replacement.

Understanding how alignment affects your symptoms can help you make decisions that reflect your goals, activity needs, and long-term joint health. A clinical review can help confirm the degree of wear, the likely benefits of correction, and whether this approach aligns with how you want your knee to function in the future.

If you would like to discuss whether high tibial osteotomy may be appropriate for your knee symptoms or general alignment, you can arrange a consultation with Dr Jonathan Negus for a personalised assessment and guidance.

This information is intended as a general guide and may not apply to every situation. Assessment and treatment recommendations vary depending on individual circumstances. Please speak with a qualified health professional for advice specific to your condition.