High Tibial Osteotomy (HTO)
A realignment procedure to reduce knee pain and slow arthritis progression
High tibial osteotomy focuses on correcting knee misalignment, often caused by conditions such as osteoarthritis or deformities that place excessive stress on one side of the joint.
Common Reasons for HTO
- Valgus Deformity: A condition where the knee angles outward, putting excessive pressure on the lateral (outer) side of the joint.
- Cartilage Damage: Localised wear in the knee due to misalignment.
- Early-Stage Arthritis: For patients who wish to delay or avoid joint replacement surgery.
The goals of the procedure are to realign the knee, relieve pain, improve mobility, and preserve the natural joint for as long as possible.
Preparation for Surgery
Before surgery, Dr Ben McGrath will perform a detailed evaluation, including imaging studies such as X-rays, MRIs, or CT scans, to assess alignment and determine the best surgical approach.
Key Steps in Preparation:
- Consultation: Dr McGrath will discuss the procedure, expected outcomes, and associated risks, ensuring you are fully informed.
- Pre-Surgical Instructions: Patients may be advised to fast and stop certain medications, such as blood thinners, before surgery.
- Lifestyle Adjustments: Engaging in pre-surgical exercises, maintaining a healthy weight, and ceasing smoking can improve surgical outcomes and recovery.
What Happens During the Surgery?
High tibial osteotomy is typically performed under general anaesthesia and involves reshaping or cutting the tibia to redistribute weight across the knee.
Surgical Steps:
- Incision: A small incision is made near the knee to access the tibia.
- Realignment: The tibia is carefully cut and adjusted to correct the alignment of the knee joint.
- Fixation: Specialised plates and screws are used to stabilise the tibia in its new position while it heals.
- Closure: The incision is closed with sutures or adhesive strips, and the leg is bandaged for protection.
The procedure typically takes 1 to 2 hours, depending on the complexity of the realignment.
Understanding the Risks
While HTO is generally considered safe, it is important to understand potential risks, including:
- Infection: At the incision site or around the hardware.
- Delayed Bone Healing: The bone may take longer than expected to heal.
- Blood Clots: Rare but possible in the lower limbs.
- Nerve or Vessel Injury: Extremely rare but a potential complication of any bone surgery.
Dr McGrath employs advanced surgical techniques and follows stringent safety protocols to minimise these risks.
What to Expect After Surgery
Immediate Post-Operative Care:
- Pain Management: Discomfort and swelling can be managed with prescribed medications and icing.
- Assistive Devices: Crutches are typically required to limit weight-bearing on the affected leg during the early recovery phase.
- Hospital Stay: Most patients stay in the hospital for one to two days for observation and initial recovery.
- Discharge Instructions: Clear guidelines will be provided on wound care, activity restrictions, and follow-up appointments.
Rehabilitation and Recovery
Recovery from HTO is gradual and follows a structured rehabilitation plan tailored to individual needs:
Phase 1: Early Healing (Weeks 0–6)
- Goals: Protect the surgical site, reduce swelling, and promote initial healing.
- Activities: Non-weight-bearing or partial weight-bearing with crutches, gentle range-of-motion exercises, and cryotherapy.
Phase 2: Strengthening and Mobility (Weeks 6–12)
- Goals: Gradually increase weight-bearing and regain strength.
- Activities: Physiotherapy for quadriceps and hamstring strengthening, light cycling, and low-impact exercises.
Phase 3: Return to Function (Months 3–6)
- Goals: Restore full strength and return to normal activities.
- Activities: Advanced physiotherapy, walking, and progressive return to physical activities.
Long-Term Outcomes
High tibial osteotomy may help reduce pain, improve alignment, and delay or avoid the need for total knee replacement. Long-term success depends on:
- Adherence to rehabilitation protocols.
- Regular follow-up appointments to monitor healing and alignment.
- Maintaining a healthy lifestyle to support joint health.
By redistributing weight and relieving pressure on the knee, HTO can enhance joint function and quality of life for patients seeking to remain active.