High tibial osteotomy
An osteotomy means breaking and realigning the bone. The tibia is the shin bone. A high tibial osteotomy is a surgical break in the tibia just below the knee joint to change the alignment of the leg. This procedure is used to control the pain as a result of arthritis affecting the inner aspect of the knee in young patients.
Commonly arthritis in young patients affects the inner aspect of the knee and as a result the normal alignment of the knee changes leading to a bow legged appearance. Due to the bow leg deformity, there can be progressive worsening of the arthritis and pain felt on the inner aspect of the knee. High tibial osteotomy (HTO) isused to relieve the pressure on the inner arthritic bearing of the knee and to redistribute the forces around the knee.
The alternative procedure to a high tibial osteotomy is a unicompartmental knee replacement, where the inner bearing of the knee is replaced with an artificial knee joint.
What happens during the knee operation?
During the surgery a small wedge of bone is removed from the upper end of the shin bone and after correcting the alignment the surgical break is held rigidly using a plate and screws.
What happens after the knee operation?
You are allowed to move the knee straight away after the operation but you may need to restrict the amount of weight that you put through the leg until the surgical break heals up. You also will need a brace for six weeks to protect the area of the break while it is healing up.
What are the long term results of knee surgery?
This knee surgery is indicated for young people with arthritis of the knee and is often used as a stop gap operation to delay joint replacement. Various studies have shown that the majority of the pain can be relieved for up to 10 years but after that period a knee replacement is often required. Performing a high tibial osteotomy avoids the risks of putting an artificial knee joint in a young patient which may need to be changed after 10-15 years. The restrictions on the activity following a high tibial osteotomy are also often less than that following a knee joint replacement.
What are the risks of a high tibial osteotomy?
The risks can include infection, deep vein thrombosis (a blood clot in the leg veins), delayed healing at the site of the surgical break, under and over-correction of the bow leg deformity.