High Tibial Osteotomy
A high tibial osteotomy involves a surgical cut of the bone at the top of the tibia. Generally, a hinge of 5-10mm is made to improve the alignment and offset potential issues of the knee. Bone graft, plates, and screws are used to hold open the high tibial osteotomy. Some high tibial osteotomies involve taking out bone where you let the leg compress on itself; this is called a closing wedge high tibial osteotomy. Most osteotomies done are opening wedge as previously described.
There are a number of different indications for a high tibial osteotomy. The first is if patients are extremely “bow-legged,” and there is a need to realign the knee to prevent further damage to the area seeing the most load. The second is in patients who have arthritis on the inside of the knee and are too young for a standard partial knee replacement. Generally, these patients are younger than 55 years old. If patients have bow-legged knees and arthritis, this can be a very effective surgery and delay the need for a knee replacement. This realignment moves the force on the arthritis part of the knee to the normal part of the knee.
The final patient type is very young patients who need cartilage, ligament, or meniscus transplant procedure with alignment issues. This surgery is very successful in these cases and can dramatically improve the success of these procedures if done in conjunction. For the meniscus and cartilage transplant patients, “realigning” the knee can increase the healing of the transplant and improve survival. For ligament issues, “realigning” the knee can stabilize the knee better in patients with torn PCL or ACL injuries.
How do you determine if you need an osteotomy?
Dr. Garcia will usually take limb alignment films to identify if a correction is needed. For arthritis, patients with more than 5 degrees of “bow legged” or varus knee need corrections. For cartilage patients, the cut off is slightly lower at 3-4 degrees of varus. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed.
What are the complications?
The main complications are listed below:
- Non Union (does not heal)
- Pain from the plate
The most worrisome complication is that the boney cut does not heal. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk.
What are the outcomes of high tibial osteotomy?
In general, this is a successful procedure if done for the right indications. For those with arthritis the success rates are 80% of patients at 10 years are pain free and do not undergo knee replacement. Additionally, compared to knee replacement patients, these high tibial osteotomy patients are allowed to participate in more rigorous sports activities. Compared to a knee replacement, we can save the knee so these young patients don’t have a risk of wearing down their replacement. For younger patients with ligament and cartilage surgeries, the success rate is much higher and these procedures can last upwards of 20+ years.
What is the Rehab and Recovery like?
After surgery patients are non-weight bearing for 6 weeks. X-rays are taken at each visit to confirm healing and check alignment. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. In general return to sports can be less than 6 months in patients with isolated issues. For larger procedures in younger patient, full recovery may take longer based on the other procedures performed.