Julian Stoddart

High Tibial Osteotomy



What Is A High Tibial Osteotomy?


A high tibial osteotomy (HTO) is an operation that realigns the load through the knee.  It involves cutting (osteotomy) the shin bone (tibia) near the knee joint (high).  The bone is then angled at the cut and held with a plate until it heals.  Angling the bone shifts more of the body weight to the undamaged part of the knee.




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A plate is used to secure the bone when a high tibial osteotomy is performed




Who Benefits From A High Tibial Osteotomy?


An HTO is useful for patients with damage limited to the inner half of the knee joint.  This is commonly the case with knees damaged secondary to trauma to the cartilage disc's (menisci).  HTO is used to relieve pain where non-operative treatment has failed.


HTO is also used in some cases of knee instability.


HTO is usually recommended for those under 55 years of age with a mobile knee.  It is considered a good option for a young, heavy male working in a heavy job.


An HTO is often used in younger, high demand patients to delay the need for a full knee replacement.


A stiff knee or one with widespread damage is not a candidate for an HTO.




A - A normal knee with a smooth joint surface


B - An arthritic knee with wear of the inner half of the joint




What Is Involved For The Patient?


  • Usually two to three nights in hospital

  • A spinal or general anaesthetic (either way you wont hear or see anything)

  • The operation takes 70 - 80 minutes

  • One six centimetre long incision below the knee and two to three smaller incisions

  • Partial weight bearing after surgery for six to eight weeks

  • Crutches for six to eight weeks

  • Driving depends on which leg is operated on

A - The shin bone has been cut and wedged open


B - The plate has been applied to the bone




What Is The Recovery Period?


Recovery from the operation is the time it takes for the cut bone to heal. Full healing takes over six months but the leg is strong enough to fully weight bear on after two to three months.  Rehabilitation involves physiotherapy for muscle strengthening and knee motion.  Heavy work is not possible until at least 4 months after surgery.


The metal plate is often removed once the bone has healed.  This is at least one year after the HTO and is a relatively minor operation.




What Is The Success Rate Of A High Tibial Osteotomy?


Approximately  7 out of 10 patients who have an HTO are satisfied.


  • 75% return to work and or sport

  • When an HTO fails with time it is usually converted to a total knee replacement

  • About 85% of HTOs are still functioning at 5 years

  • About 75% of HTOs are still functioning at 10 years

  • Because there are no artificial components in the knee joint, activity is less restricted after an HTO compared to replacement operations




What Are The Risks Of A High Tibial Osteotomy?


All operations carry some risk.  High tibial osteotomy is a safe operation but occasionally complications occur.


Risks common to all operations include:


  • Infection

  • Blood clots in the legs

  • Bleeding

  • Damage to surrounding nerves and blood vessels

Risks particular to an HTO include:


  • Knee stiffness

  • Angling the cut bone too little or too much

  • Failure of the cut bone to heal

  • Discomfort from metalware requiring its removal

  • Unexpected fractures around the bone cut

  • In time, failure of the rest of the knee




Why Have Julian Perform Your High Tibial Osteotomy


Julian is very experienced in computer assisted knee surgery.  He now utilises this technology to measure the change in angle at the cut shin bone very accurately.  This reduces the risk of an under or over correction of the bone.   Angling the bone correctly increases the chance of surgical success.


Julian uses one of the strongest fixation plates available reducing the risk of the angled bone losing position.




I Think I May Benefit From A High Tibial Osteotomy


If you think you may benefit from a high tibial osteotomy please arrange a consultation with Julian Stoddart.  You will receive a comprehensive assessment of your knee to determine if this operation is right for you.




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