High tibial osteotomy (knee realignment surgery)

You might need a private high tibial osteotomy if you have early-stage osteoarthritis, which leads to pain and stiffness in your joints and can be caused by a range of factors, including:

• Overusing and/or injuring your joint
• Other conditions, such as rheumatoid arthritis or gout
• Old age
• Family history (osteoarthritis can be hereditary)
• Obesity
• Gender (osteoarthritis occurs more in women)

There are a number of other knee conditions that can be treated with a high tibial osteotomy, such as knee malalignment and posterolateral instability (disruption of your knee ligament system).²

The cost of a high tibial osteotomy with Circle Health Group depends on a variety of factors, including which hospital and surgeon you choose, and the extent of damage to your knee.

 If you would like an estimated quote for limb deformity correction surgery, give us a call and our dedicated advisors can put one together based on your personal circumstances.

If you are paying for your own treatment, our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant’s outpatient appointment fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over 10 months to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 14.9% APR.

If you have private health insurance, this type of surgery will usually be covered by your provider. Speak to your insurer directly to find out more information on this.

In most cases, we will provide a high tibial osteotomy when you have severe joint pain and stiffness in your knee caused by your bone not being properly aligned and too much pressure being placed on one side of your knee. If you have any of the below symptoms, it is possible that you have a misaligned knee joint and might need a high tibial osteotomy.

• Sensitivity in your knee area
• Increased pain in your knee when you haven't moved for a while
• Knee joints looking larger
• Bone spurs (extra bits of bone, like hard lumps, that form around your affected joint)
• A grating and/or cracking sound when moving your knee
• Weakness and muscle wasting (when you lose muscle bulk around your knee)
• Stiffness and reduced flexibility in your knee
• Swelling

These symptoms can happen as a result of various knee problems and conditions, so it's important to speak with a specialist to get an accurate diagnosis. Our consultant knee surgeons can identify what's causing your knee problems and they'll let you know whether a high tibial osteotomy could help you.

Your consultant may recommend a high tibial osteotomy to treat any knee condition that has led to you having incorrect alignment with your knee joints. While there are many knee problems that a high tibial osteotomy can be used for, the two most common conditions treated by this surgery are osteoarthritis and malalignment.

Osteoarthritis

Osteoarthritis is a 'wear and tear' disease, which means it develops over time due to constant strain on your cartilage. This strain can occur when the bones in your knee and leg don't line up properly, putting additional stress on either the inner or outer part of your knee. When your cartilage that cushions the end of your bones experiences this extra stress over a period of time, it gradually deteriorates and wears down, meaning that one bone rubs against another.

If left untreated, osteoarthritis can affect your entire knee joint. The degeneration of your protective tissues (small fibres that strengthen and lubricate your joint and hold it together) limits your knee's capacity to glide smoothly, leading to pain, reduced movement, and a popping, locking, and clicking sound when you move your knee.³

Knee malalignment

Knee malalignment occurs when there is an uneven distribution of weight across your knee joint. This can be caused by athletic exertion, gradual pressure, an injury healing incorrectly, or be present from birth. If there is excessive weight on one side of your knee, the protective tissue on that side wears more than the other, leading to a repetitive cycle of damage and reduced function of your knee in general. Over time, this malalignment can lead to your knee being angled in an inward position (knock knee) or in an outward position (bow leg).⁴

Your consultant will carry out a series of tests to see if you need a high tibial osteotomy. They will start by performing a physical examination, ahead of running you through some scans. After making these checks, your consultant will be able to confirm whether you would benefit from a high tibial osteotomy.

Physical examination

To start with, your consultant will get a full history of your symptoms and any past treatment, along with learning about what activities you do. This helps them rule out any other conditions that may have contributed to your knee joint pain and see whether an alternative to a high tibial osteotomy would be more appropriate for you.

They will then gently perform a physical examination, checking your affected joint for tenderness, swelling, or redness, along with seeing if you have any outward deformities (bow leg, knock knee, etc.). Another part of the examination might be some range of motion tests, such as determining how flexible your joint is and whether you have ligamentous instability (when your joints extend beyond the normal range of motion).

Scans

The next phase of your initial consultation will involve some scans. Usually, your consultant will want to carry out an X-ray and MRI scan, and they may deem it appropriate to run you through some other tests as well, such as testing your joint fluid for inflammation.

X-ray

Although your cartilage itself doesn't show up on X-ray images, your consultant will be able to check for cartilage loss by seeing if there's been a narrowing of space between the bones in your joint. They can also check for bone spurs, which can be a sign of high levels of pressure on a certain part of your bone due to uneven weight distribution in your knee.

MRI scan

Using radio waves and a strong magnetic field, your consultant will produce detailed images of your bone and cartilage, allowing them to see whether any tissue has been eroded and created an imbalance of weight in your knee. An MRI isn't always necessary, but your consultant may order one to determine the exact severity of your knee joint issue.

There are several ways you can prepare for a high tibial osteotomy.

Prepare for a hospital stay

After your high tibial osteotomy, you will have to stay in hospital for one or two nights, as this allows us to see how you've responded to the surgery, provide pain relief, and give you all the guidance and resources you need for recovering at home. Ahead of coming to hospital, then, remember to bring anything that might be useful during your stay with us. We would recommend bringing some loose-fitting clothing to wear, along with a laptop/tablet to keep yourself entertained.

You will also need to think about returning home from hospital. You won't be able to drive, or use public transport, so it would be best for you to arrange a taxi in advance, or see if a friend or family member can give you a lift.

Set up your recovery space at home

Generally, it takes two weeks before you can put weight on your leg again after a high tibial osteotomy, so you'll need to make sure that you have a recovery space on the ground floor of your home to avoid unnecessary trips upstairs. Given that your mobility will be considerably limited during these early stages, be sure to stock up on all the supplies you might want beforehand. If you need anything else as you recover, see if a family member or friend can pop to the shops for you.

Be mindful of any tripping hazards at your home as well. This could be uneven flooring (loose tiles, rugs, or carpets), furniture, or just general mess that might cause you to trip.

Stop smoking

We always recommend that you stop smoking at least two weeks before your high tibial osteotomy. This is because smokers have an increased chance of experiencing problems with breathing and their heart after surgery, along with being more at risk of not recovering fully. You will also need more general anaesthetic if you are a smoker, which can cause complications. So, if you are a smoker and need some help with stopping before your treatment, do get in touch with your consultant.

Medication

Prior to your high tibial osteotomy, you will need to stop taking any blood-thinning medications that may increase your chances of unwanted bleeding during and/or after surgery, such as aspirin, anti-inflammatory medications, or warfarin. Your consultant will speak to you about this when they schedule you in for surgery and make sure you aren't taking any medications that could cause issues.

Weightloss

If you are overweight, your consultant may ask that you lose weight before undergoing surgery. Weightloss reduces the chance of complications during surgery and can also help you recover faster. They will give you plenty of advice about how to do this in a safe, healthy way.

Food and drink

Avoid eating or drinking anything after midnight on the day of your surgery. Please also take care to eat a balanced diet; your consultant will speak to you about foods you should have, as well as avoid, in the lead-up to your procedure. You should also refrain from drinking any alcohol 48 hours before the surgery.

A high tibial osteotomy typically lasts between one and two hours, and is performed under general anaesthetic. This means that you’ll be asleep for the full operation and won’t feel any pain at all.

Your surgeon will start by making an incision at the front of your knee, just below your kneecap. At this stage, they will use guide wires to map out the exact part of the bone in your knee that needs to be removed to restore a correct weight balance. Using an oscillating saw, your surgeon cuts along the guide wires, removing the wedge of bone – either on the outside of your upper shin bone or just under the side of your knee that has healthy cartilage, depending on what is most appropriate for your condition.

Having removed a part of your bone to take pressure off the damaged side of your knee joint, they will then close the area where they removed the bone with a metal plate or pins. Doing this brings the bones on the healthy side of your knee closer together and allows for more space on the damaged side, ensuring that no more friction between your bones takes place.

Once the pins are in place and your leg has been straightened into a correct shape, your surgeon will close your wound with stitches or staples ahead of applying a dressing.

Some surgeons favour a method of high tibial osteotomy that is supported by computer assisted navigation. This involves using real time infra-red wave communication technology that tracks the position of your bones in 3D space as your surgeon is performing the operation. There are a number of benefits to operating in this way, such as:

Greater accuracy

Ahead of performing high tibial osteotomy assisted by computer navigation, your surgeon will carry out a radiographic evaluation. This is particularly useful, as it allows them to pick up a full-length alignment view of your knee. They can then understand the precise extent of your joint deformity, which in turn means they can see what kind of angular correction you will need for your knee to return to a straightened position.

Fewer mistakes

During the operation, your surgeon can digitally monitor each step of the process on a screen in real time. This means they have much more control, especially in deep areas that would be hard to see with a conventional osteotomy. They can be sure, at every stage, that they are correctly following what was mapped out in your radiographic elevation, making any adjustments wherever necessary.

Everyone is different, so there is no fixed timeframe for a complete recovery from a high tibial osteotomy. The factors that can affect your personal recovery timeline include:

• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age
• Your reason for having the surgery

Recovering in hospital

When you wake up from surgery, you will feel quite groggy, which is completely normal as your general anaesthetic wears off. You will be taken to a private hospital room and given pain relief medication to help with any discomfort you might be experiencing.

A cast or brace may be placed over your leg as it heals. You will need to stay with us for one or two nights, depending on how you recover, so that we can monitor how you have responded to treatment, check your wound, and make sure you feel comfortable using your crutches.

Three days to two weeks after surgery

After your high tibial osteotomy, you will need to use crutches for a few weeks, and you'll be encouraged to avoid putting any weight on your leg as heals during this period. Your consultant will speak to you about when weight bearing can begin, as this varies for everyone. In the meantime, take care to rest as much as possible with your leg elevated and iced to reduce swelling and speed up the healing process.

You will continue to experience some pain and swelling, so we’ll be sure to provide you with enough pain relief medication. After 10 days to two weeks, you will make another visit to one of our hospitals so that we can remove your stitches. We shall pencil this in for you as you're recovering from surgery.

Two to six weeks after surgery

After two weeks, you will probably still need to use crutches. Gradually, though, you should be able to put some weight on your leg. Your consultant will let you know when it’s appropriate for you to do this. A physiotherapist will work closely with you throughout your recovery period, helping you regain full range of motion and increase muscle strength and endurance, as this will also speed up recovery.

You won't be able to drive until around six weeks after your high tibial osteotomy. Your leg will still be swollen and require icing during this period, so take care to avoid long drives. At this stage, you will also have a follow-up appointment with your consultant. They will take an X-ray to confirm that your bones are correctly positioned and growing like they should be, after which they will let you know where you are in your recovery process and give some advice about the kind of physiotherapy you can do.

Six weeks to three months after surgery

When it comes to when you can return to work, this may take anywhere up to three months after surgery. If you have a desk job, the amount of time can be less, but be wary that even prolonged sitting can make your knee swell up, increase your pain, and slow down the rate of healing. If your job requires more physical exertion, you may not be able to make a full return to work for four to six months.

By this stage, you will be able to walk around normally. Working with your physiotherapist, you’ll be gently guided towards making a full return to everyday activities. They will advise you on when you can start doing certain activities, such as running, along with giving you rehabilitation exercises that you can do whenever you like. Common strength-building exercises may include stationary biking, swimming, rowing, and other forms of low-impact cardiovascular exercise that address important muscle groups like your buttock, hip, thighs, and calf.  You should be able to make a full recovery in three to six months.

Like with any surgery, some complications can occur with a high tibial osteotomy, but these are very rare. You will have the chance to ask your consultant questions or raise any concerns you might have, and they will take time to explain the risks to you before the surgery takes place.

General complications of any operation:

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of high tibial osteotomy

• Bones failing to heal and properly fix together
• Continued symptoms (stiffness and pain)
• Injury to vessels and nerves
• Swelling, bruising, and/or numbness
• Irritation from the metalwork
  
• Compartment syndrome (restriction of blood flow to muscle groups that leads to pain when exercising)
• Need for a full knee replacement

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans adapted to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about high tibial osteotomy, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1 Osteotomy of the knee, OrthoInfo
² High tibial osteotomy, NIH
³ Knee surgery: High tibial osteotomy, HSS
⁴ Knee malalignment, Schoen Clinic
⁵ Computer-assisted surgery and navigation in foot and ankle: state of the art and fields of application, Bio Scientifica