High Tibial Osteotomy Surgery


A painful osteoarthritic knee in a middle-aged recreational patient is one of the most difficult problems to manage. Initially, all patients should be treated conservatively; however, when pain worsens as the osteoarthritis progresses, surgical treatment should be considered. There are two major types of osteoarthritis in the middle aged-post traumatic and non-traumatic. Post-traumatic osteoarthritis occurs in patients who have had a previous knee injury as a young adult and may have had their meniscus, or part of it removed surgically. Non-traumatic osteoarthritis occurs in patients who have not had a previous knee injury and in whom the osteoarthritis is strongly genetically determined. Such patients often report a family history of early osteoarthritis.

Signs and Symptoms:
The predominant symptoms of osteoarthritis of the knee are pain, swelling, stiffness and a decreased activity level. The pain generally worsens with activities and improves with rest. Commonly, wasting of the thigh muscle occurs. This in turn may increase pain and may also cause symptoms of giving way. Symptoms such as locking and catching may also be present.

Treatment Options:
An osteoarthritc knee in a young patient is a difficult problem to manage. Only certain patients will respond well to osteotomy, therefore Dr Lyman will carefully consider whether you are a likely successful candidate. Some patients are able to be successfully managed with conservative means but for the middle aged patient this may lead to early joint replacement as an osteotomy is most successful when performed during the early stages of osteoarthritis.


Osteotomy is an appropriate surgical option in selected cases of arthritis affecting one side of the knee only. The purpose of osteotomy is to transfer the load to an uninvolved joint surface. Osteotomy is most commonly performed for patients where the weight bearing surfaces of the knee joint become worn away on one side. The affected side of the joint is no longer smooth and free running and this leads to stiffness and pain. In this situation, high tibial osteotomy is performed.

It should be stressed that these osteotomies are designed to allow patients to walk without discomfort, not to return them to sporting activities. If adequate correction is achieved, the success rate of high tibial osteotomy at this practice is 91% at the 5 years and 80% at 10 years. Those patients who fail to achieve such long-term relief usually obtain at least a few years of relief and are then eligible for joint replacement. Osteotomy is strongly recommended for the middle-aged patient with osteoarthritis. If the patient is nearing the age of 60, it is worth considering continuing with conservatives measures for as long as possible so that when complete deterioration of the joint has occurred, joint replacement may be performed.


After the Surgery:
When you wake after surgery you will be in the recovery ward.