High tibial osteotomy

What is tibial osteotomy surgery?

A tibial osteotomy, sometimes known as knee realignment surgery, is an operation on the shinbone (tibia) to change its shape in order to correct alignment issues or deformities. Surgeons cut the bone and either remove a wedge of bone or open a gap in the bone to shift weight away from a damaged or worn part of the knee, then hold this in place with metal screws or plates until the bone heals in its new position. It’s usually done to relieve pain, improve function, and delay the need for a full knee replacement.

What conditions can tibial osteotomy treat?

This surgery is most often used for people with early to moderate osteoarthritis affecting one side of the knee, particularly the inner side (medial compartment). It can also help those with knee deformities, like bow-leggedness, where the joint wears unevenly, causing discomfort and stiffness.

Is a high tibial osteotomy right for me?

A high tibial osteotomy might be suitable if you have:

• Knee pain from wear on one side of the joint
• Good knee movement
• Are physically active.

It’s generally recommended for people under 60 who wish to stay active and delay more invasive procedures, such as a knee replacement. Your consultant will assess your symptoms, activity levels, and X-rays before deciding if it’s appropriate for you.

It is particularly useful for:

• People with early to moderate osteoarthritis
• If your knee joint has become worn due to overuse or injury
• Deterioration of the joint due to cartilage loss.

What happens during a high tibial osteotomy?

Tibial osteotomy is usually performed under general anaesthesia and can take up to two hours to complete.

Your surgeon may begin with an arthroscopy to do a final assessment of your knee joint before the main procedure. Using a tiny camera and instruments inserted through small incisions (cuts), they will examine the joint and then proceed with the tibial osteotomy surgery.

During surgery, an incision is made in the skin on the upper tibia (shinbone) and a cut is made through the bone at a pre-planned angle. Your surgeon will either remove a small wedge of bone or open a gap to realign the knee. This creates more space and reduces pressure on the damaged area. The bone is then secured with a metal plate and screws, and the wound is closed with stitches and dressed.

Preparing for a high tibial osteotomy

Before your operation, you’ll have a consultation and may need an X-ray or MRI scan to assess the condition of your knee joint.

You may be asked to avoid certain medications and fast for a set time before surgery. The healthcare team will explain the procedure, risks, and what to expect on the day.

If you are overweight, you may also be asked to try to lose some weight to aid your recovery process after the surgery. It is also very important to avoid smoking or vaping for 6 weeks before and 3 months after osteotomy surgery, as nicotine can affect bone healing.

Recovery from a high tibial osteotomy

A full recovery can take up to 6 months, but this will vary from patient to patient. Your recovery schedule may look similar to the following:

Immediately after surgery:
You may need to stay in the hospital for 1 - 2 nights and to use crutches for up to 6 weeks to keep weight off your knee. You will also need to manage pain and swelling with rest, ice, compression, and elevation (RICE).

It is important to begin gentle stretches and exercises immediately after your surgery, so your knee does not become stiff. Our healthcare team will give you physiotherapy exercises to support this. You will also be given pain relief for any discomfort or swelling.

2 - 6 weeks after surgery:
During this time, you will start to bear weight on your knee again. It is important to do this gradually so as not to cause any damage while the bone is healing. However, your physiotherapy team will help you regain a full range of motion and begin to strengthen your knee with a tailored programme of recovery exercises.

You will also be able to start driving around 6 weeks after your surgery, but only when you feel comfortable and strong enough to use the pedals correctly.

8 - 12 weeks:
You will continue to strengthen your knee joint as well as the surrounding muscles with your physiotherapy exercises. You will also be able to return to most daily activities at this point and start to try lower-impact exercise such as cycling or swimming, with higher intensity movements coming closer to the 3-month mark of your recovery. Your consultant will also take X-rays to check that your bone is aligned correctly and healing well.

A full recovery and full return to sports can be expected at around 6 months after your surgery.

What are the benefits of tibial osteotomy?

The main benefits include reduced knee pain, improved mobility, and a delay in needing a total knee replacement, which in turn can help you to return to exercise and daily activities, as well as improve your quality of life.

It can also help with aiding your walking patterns since the joint will be better aligned, with the weight and pressure now shifted away from the damaged area of your cartilage.

Tibial osteotomy has a very high success rate, with the vast majority of patients receiving great results, allowing them to return to sport and daily activities.

How long do the benefits of a high tibial osteotomy last?

Benefits typically last between 5 and 10 years, although for some people, the improvement can be even longer. This will depend on your activity levels, weight, and the progression of arthritis over time.

What are the risks of high tibial osteotomy?

Most people recover well from tibial osteotomy, but like any surgery, it carries risks. Your consultant (surgeon) will talk you through these risks, answer any questions, and help you feel more confident going into surgery.

Specific complications of high tibial osteotomy

• Your bones are not healing or aligning properly.
• Damage to nerves or blood vessels around the knee.
• Blood clots (Deep vein thrombosis).
• Your discomfort and symptoms continue even after the surgery.
• Complications or irritation from the metal implants around your joint.
• Your knee might not be perfectly straight or aligned after surgery.
• The need for a full knee replacement or further surgery, if the tibial osteotomy procedure was not successful.

However, these complications are rare, and your consultant will discuss these risks with you thoroughly before your procedure.

Possible side effects following high tibial osteotomy surgery

As with all surgery, there are some common side effects, including swelling, bruising, and stiffness around the knee. Temporary numbness near the incision is also possible. Pain can usually be managed with medication, and it will gradually improve as you recover.

Alternatives to high tibial osteotomy

Alternatives include non-surgical treatments such as physiotherapy, pain relief, brace treatment, and joint injections, such as Arthrosamid®.

If your osteoarthritis worsens, a partial or total knee replacement might be considered. Not all patients are suitable for these, which is why a tibial osteotomy can be a useful middle ground.

How much does a high tibial osteotomy cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.