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What Is High Tibial Osteotomy?

High tibial osteotomy is knee-preservation surgery that cuts and realigns the upper tibia to shift weight away from a damaged compartment of the knee. It is most commonly used for medial-compartment osteoarthritis associated with varus, or bowlegged, alignment. Changing the mechanical axis transfers more load toward healthier cartilage in the opposite compartment. The correction can be created with a medial opening wedge or a lateral closing wedge technique.

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What Is High Tibial Osteotomy?

High tibial osteotomy is knee-preservation surgery that cuts and realigns the upper tibia to shift weight away from a damaged compartment of the knee. It is most commonly used for medial-compartment osteoarthritis associated with varus, or bowlegged, alignment. Changing the mechanical axis transfers more load toward healthier cartilage in the opposite compartment. The correction can be created with a medial opening wedge or a lateral closing wedge technique.

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Why Is High Tibial Osteotomy Performed?

The procedure is used for selected active patients with symptomatic unicompartmental knee arthritis and correctable malalignment who want to preserve their native knee joint. It is particularly suited to medial-compartment disease with varus alignment when the lateral and patellofemoral compartments remain reasonably preserved. Surgeons assess mechanical alignment, ligament stability, knee motion, cartilage condition, age, activity level, and body weight before recommending surgery. Advanced multicompartment arthritis or severe loss of motion can make knee arthroplasty more appropriate.

How Is High Tibial Osteotomy Performed?

The surgeon plans the correction using standing alignment imaging and creates a controlled bone cut in the proximal tibia. In a medial opening-wedge osteotomy, the inner side of the tibia is gradually opened while a lateral bone hinge is preserved. In a lateral closing-wedge osteotomy, a wedge of bone is removed and the gap is closed to change alignment. A plate and screws or another fixation system stabilize the tibia while the osteotomy heals, and bone graft or a substitute can be added in selected opening-wedge procedures.

What Is Recovery Like After High Tibial Osteotomy?

The knee is protected with crutches and limited weight-bearing while the tibial osteotomy begins to heal. Physical therapy progresses range of motion, quadriceps strength, gait, and gradual loading according to imaging and the surgeon's protocol. Follow-up X-rays are used to evaluate bone union and maintenance of the planned correction. Return to running, heavy labor, or pivoting sports takes several months and depends on healing, strength, symptoms, and associated procedures.

What Are the Risks and Complications?

Possible complications include infection, blood clots, stiffness, hardware irritation, delayed union, nonunion, loss of correction, and neurovascular injury. A lateral hinge fracture is a recognized complication of medial opening-wedge high tibial osteotomy. Lateral closing-wedge techniques can place the common peroneal nerve at risk because of the operative approach near the fibular side of the knee. Some patients later require hardware removal or conversion to partial or total knee arthroplasty as arthritis progresses.

Frequently Asked Questions About High Tibial Osteotomy

How does high tibial osteotomy reduce knee pain?

Realigning the tibia shifts the mechanical load away from the worn compartment and toward healthier cartilage, reducing stress on the arthritic side of the knee.

What is the difference between opening-wedge and closing-wedge HTO?

Opening-wedge HTO opens a controlled gap on one side of the tibia, while closing-wedge HTO removes a wedge of bone and closes the resulting space.

Is high tibial osteotomy a knee replacement?

No. It preserves the native knee joint and changes bone alignment rather than replacing the joint surfaces with metal and plastic implants.

Can knee replacement still be needed after high tibial osteotomy?

Yes. HTO can delay joint replacement in selected patients, but osteoarthritis can continue to progress and later require partial or total knee arthroplasty.

References

Osteotomy of the Knee. OrthoInfo, American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/osteotomy-of-the-knee/. Date Accessed August 13, 2026.

Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: indications, surgical technique and outcomes. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC8758909/. Date Accessed August 13, 2026.

High tibial osteotomy in varus knees: indications and limits. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC4993553/. Date Accessed August 13, 2026.

Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. PubMed. https://pubmed.ncbi.nlm.nih.gov/21036048/. Date Accessed August 13, 2026.

Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review. PubMed. https://pubmed.ncbi.nlm.nih.gov/36779579/. Date Accessed August 13, 2026.