The Right Patient, the Right Surgery: Everything You Need to Know About High Tibial Osteotomy

Do you suffer from knee pain and deformity? If knee replacement seems premature but your quality of life is decreasing, High Tibial Osteotomy (HTO) might be the ideal option. In this article, we explain who is a suitable candidate, how the procedure works, and what factors increase success.

What is High Tibial Osteotomy (HTO)?

HTO is a surgical procedure that corrects the alignment of the knee joint to redistribute weight. It is especially used in patients with medial (inner side) knee osteoarthritis and varus deformity (bow-leggedness). By shifting the load to the healthier part of the joint, it reduces pain and slows cartilage damage.

Why is it Performed?

• Medial compartment knee osteoarthritis
• Varus alignment (bow-leggedness)
• An alternative to knee prosthesis in young, active patients

Who is the Ideal Candidate?

• Between 40 and 60 years old
• Medial knee pain due to arthritis
• Desire to maintain an active lifestyle
• Normal weight range
• Good range of motion in the knee

Who is Not a Suitable Candidate?

• Advanced generalized knee osteoarthritis
• Rheumatologic diseases
• Severe obesity
• Restricted knee motion

What to Consider in Patient Selection?

• Full-leg X-rays to measure alignment
• Assessment of cartilage status via MRI
• Patient’s age, activity level, and weight

Surgical Technique 

During surgery, the shinbone (tibia) just below the knee is precisely cut and slightly opened to create a wedge. This wedge changes the mechanical axis of the leg to offload the damaged side of the knee. The bone is stabilized using a plate and screws and may be supported with bone graft if needed.

Postoperative Recovery

• Use of crutches for the first few weeks
• Gradual weight-bearing after week 6
• Return to daily activities around 3 months
• Return to sports or intense activities within 6 months

Factors That Improve Success

• Proper patient selection
• Experienced surgeon and accurate technique
• Compliance with physical therapy
• Non-smoker lifestyle
• Maintaining ideal body weight

Conclusion

High Tibial Osteotomy can offer a pain-free life without the need for knee replacement in the right patient. With proper planning and surgical execution, it is possible to preserve the natural joint for many years.