High tibial osteotomy
Changing the alignment of the knee to move load away from the worn part—while keeping your own joint.
If arthritis is affecting mainly one side of your knee and your leg alignment is contributing to that overload, replacing the entire knee may not always be the only option.
In the right patient, a high tibial osteotomy can redistribute the load and preserve the native knee.
What getting back to your life can look like
Unlike soft-tissue procedures, this is a bone-healing operation.
Your recovery therefore progresses according to both your knee function and the healing seen on X-rays.
The pathway generally includes:
- Early protection: limited weight-bearing and support as advised.
- Progressive loading: weight-bearing increases as the bone heals.
- X-ray reviews: imaging confirms how the osteotomy is uniting.
- Walking independently: support is reduced as strength and healing allow.
- Return to activity: activity is increased progressively once the bone and knee are ready.
Your exact milestones depend on the correction performed, bone healing, your strength and the rest of your knee.
Bone healing cannot be rushed simply because you feel ready to move faster.
In ordinary words
If the leg is bow-legged, more of the body’s load can pass through the inner side of the knee.
Over time, that compartment may wear while other parts of the knee remain relatively healthy.
A high tibial osteotomy changes the alignment of the upper shin bone so that the load is redistributed towards the healthier part of the knee.
It does not replace the joint.
You keep your own knee.
Is preservation right for you?
High tibial osteotomy is suitable only for a specific pattern of knee disease.
We consider:
- where the arthritis is located
- the alignment of the leg
- the condition of the other compartments
- cartilage quality
- ligament stability
- age and activity level
- your expectations from the knee
If arthritis is widespread throughout the knee, an osteotomy is unlikely to solve the underlying problem.
If the pattern is suitable, however, changing the load on the joint may allow an active person to preserve their own knee for many more years.
Preservation is valuable—but only when the knee is suitable for preservation.
What happens if you do not have an osteotomy?
Treatment may include strengthening, activity and load modification, weight management where appropriate, an unloader brace or injections.
These approaches can control symptoms for a considerable period in some patients.
What they do not do is correct the underlying alignment.
The trade-off is important: an osteotomy involves a significant operation and a longer recovery than many non-surgical treatments. In the right patient, that recovery may be worthwhile because the aim is to preserve the native knee.
For the wrong patient, it is simply a major operation without enough benefit.
The decision is therefore about suitability, not about choosing preservation at any cost.
What does a high tibial osteotomy involve?
The operation is performed through an incision around the upper part of the shin.
A controlled cut is made in the bone and the alignment is corrected by the planned amount. A plate and screws hold the bone in its new position while it heals. Bone graft or a bone substitute may sometimes be used.
The procedure may be performed under spinal or general anaesthesia depending on your circumstances.
Recovery is different from that of a purely soft-tissue procedure because the bone must unite before it can safely take full load.
Questions patients ask
01 Is this instead of a knee replacement, or just delaying one?
The aim is not to promise that you will never need a replacement. The aim is to preserve your own knee for as long as the condition of the joint and your lifestyle make that a sensible choice.
We will be honest about what we think an osteotomy can realistically achieve in your case.
02 Does the plate stay in?
Most plates can remain in place if they are not causing problems. If the plate becomes uncomfortable, removal may sometimes be considered after the bone has healed.
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