High Tibial Osteotomy (HTO): A Joint-Preserving Solution for Knee Pain | Article by Dr Sunny Dole Knee Surgeon in Pune

High Tibial Osteotomy - A novel option to Knee Replacement Surgery

High Tibial Osteotomy (HTO): A Joint-Preserving Solution for Knee Pain

By Dr. Sunny Dole | Orthopedic Surgeon | Knee Preservation & Joint Replacement Specialist, Pune

Knee pain resulting from early arthritis or malalignment can significantly affect the daily functioning and quality of life of active individuals. When patients are too young or too active for a total knee replacement, one effective joint-preserving solution is High Tibial Osteotomy (HTO). This surgical technique has gained prominence for its ability to realign the knee joint, relieve pain, and delay the need for joint replacement surgery.

This article provides a comprehensive overview of High Tibial Osteotomy (HTO), including its indications, surgical procedure, benefits, diagnostic process, and post-operative recovery. It is especially relevant for patients in Pune who are exploring joint-preserving alternatives to total knee replacement.

What is High Tibial Osteotomy?

High Tibial Osteotomy is a surgical procedure performed on the upper part of the tibia (shinbone) to realign the knee joint. It is primarily indicated for patients with unicompartmental osteoarthritis affecting the medial (inner) side of the knee. By correcting the alignment, the surgeon shifts the body’s weight-bearing axis away from the damaged area to the healthier lateral compartment.

This redistribution of forces can relieve pain, improve function, and significantly delay the progression of arthritis, thereby postponing the need for total knee replacement.

Indications for High Tibial Osteotomy

HTO is suitable for selected individuals who meet the following criteria:

• Medial (inner) compartment osteoarthritis of the knee

• Varus deformity (bow-legged appearance) contributing to uneven load distribution

• Age typically below 60 years with good bone quality

• Good range of motion in the knee joint

• No significant arthritis in the lateral or patellofemoral compartments

• Active lifestyle or desire to return to physically demanding activities

• Failure of conservative treatments such as medications, physiotherapy, weight loss, and injections

Ideal Candidate: A younger, active patient with pain primarily on the inner side of the knee and noticeable bowing of the leg.

Types of High Tibial Osteotomy

There are two main surgical techniques:

1. Opening Wedge Osteotomy:

   • A cut is made on the medial side of the tibia.

   • The bone is slowly opened to a predetermined angle.

   • The gap is filled with a bone graft or synthetic material.

   • A metal plate and screws are used to secure the correction.

2. Closing Wedge Osteotomy:

   • A wedge of bone is removed from the lateral side of the tibia.

   • The remaining bone surfaces are brought together.

   • Fixation is done using plates and screws.

The Opening Wedge Technique is more commonly used due to its technical simplicity and preservation of bone length.

Pre-Operative Investigations

Before surgery, the patient undergoes detailed evaluation to confirm diagnosis and plan the correction angle:

• Standing Full-Length X-rays (hip to ankle): To assess the mechanical axis and degree of deformity

• MRI of the Knee: To evaluate the condition of cartilage, ligaments, and menisci

• Routine Blood Tests: To ensure fitness for anesthesia and surgery

• Bone Density Test (in some cases): To assess bone strength, especially in older patients

The Surgical Procedure

High Tibial Osteotomy is performed under spinal or general anesthesia and takes approximately 1.5 to 2 hours. Key steps include:

1. Exposure of the upper tibia through a small incision.

2. Using surgical instruments to make a controlled bone cut.

3. Gradual opening or closing of the bone to the desired angle based on preoperative planning.

4. Insertion of a wedge (bone graft or synthetic material) if required.

5. Fixation with a locking plate and screws.

6. Layer-wise closure of the surgical site.

Benefits of High Tibial Osteotomy

• Relieves pain in the medial compartment

• Restores normal alignment and biomechanics of the knee

• Delays or avoids the need for total knee replacement

• Maintains native knee joint, allowing greater flexibility and proprioception

• Allows return to sports and high-impact activities

• Avoids complications associated with prosthetic joints in young patients

Post-Operative Care and Rehabilitation

Recovery after HTO involves a well-structured rehabilitation plan to ensure optimal outcomes.

0 to 2 Weeks Post-Op:

• Hospital stay for 2–3 days

• Leg elevation and icing to reduce swelling

• Pain management and wound care

• Crutches or walker for mobility (non-weight bearing or partial weight bearing)

2 to 6 Weeks:

• Gradual increase in weight-bearing under supervision

• Start of range of motion exercises

• Basic strengthening exercises for quadriceps and hamstrings

6 to 12 Weeks:

• Transition to full weight-bearing as tolerated

• Advanced physiotherapy

• Muscle reconditioning and gait training

3 to 6 Months:

• Return to light sporting activities and normal routines

• Full recovery and high-impact sports after 6 to 9 months depending on healing and rehabilitation

Risks and Complications

As with any surgical procedure, HTO carries potential risks, although they are relatively rare:

• Infection at the surgical site

• Delayed bone healing or non-union

• Blood clots

• Nerve or vessel injury (rare)

• Residual pain or incomplete correction

• Need for revision surgery or eventual total knee replacement

Dr. Sunny Dole follows meticulous surgical techniques and individualized care plans to minimize complications and ensure safe recovery.

High Tibial Osteotomy in Pune by Dr. Sunny Dole

Dr. Sunny Dole is a highly experienced orthopedic surgeon with expertise in knee alignment correction and joint preservation. He offers High Tibial Osteotomy at advanced orthopedic facilities across Pune, including his primary consultation center:

Kothrud Orthopedic ClinicOffice No. 401, Saarthi Success Square, Karve Road, Opp. Karve Statue, Pune – 411038

Appointment Number: 9272106008

Google Maps: https://g.co/kgs/Nh24k8N

Conclusion

High Tibial Osteotomy is a valuable option for younger, active patients with early-stage knee arthritis or deformity. It can relieve pain, restore function, and significantly delay the need for joint replacement surgery.

If you are experiencing chronic inner knee pain and want to explore joint-preserving options, book a consultation with Dr. Sunny Dole at Kothrud Orthopedic Clinic and take a step towards pain-free mobility and a more active life.