🦵 High Tibial Osteotomy (HTO)
🔹 Definition

High Tibial Osteotomy (HTO) is an orthopedic surgical procedure where the upper part of the tibia (shin bone) is cut and realigned.

* Aim: Correct varus deformity (bow-legged knee) and treat medial compartment osteoarthritis (OA).

* It is a joint-preserving surgery, unlike Total Knee Arthroplasty (TKA) which replaces the joint.

🔹 Why It’s Done (Indications)

Doctors recommend HTO when:

* Medial knee osteoarthritis (cartilage wear inside the knee).

* Varus deformity (bow-legged → more pressure on inner side).

* Patients are younger (<60–65 yrs) and active.

* Patients want to delay knee replacement surgery.

* Good range of knee movement is still present.

🔹 Surgical Techniques

There are two main types of HTO:

1.Opening Wedge HTO

* Surgeon cuts the tibia on the inner (medial) side.

* The bone is slowly opened like a wedge.

* A plate and screws (sometimes bone graft) keep it in position.

2.Closing Wedge HTO

* A wedge-shaped piece of bone is removed from the outer (lateral) side.

* The bone ends are brought together and fixed with a plate.

👉 Both aim to shift the weight-bearing line toward the lateral side (healthier part of the knee).

🔹 Benefits

* Preserves the patient’s natural knee joint.

* Reduces pain and improves walking ability.

* Delays or avoids Total Knee Arthroplasty (TKA).

* Allows return to sports or heavy physical activity.

🔹 Risks / Limitations

* Not suitable for advanced OA in all compartments.

* Recovery may take several months.

* Possible complications:

* Bone healing problems (non-union).

* Over- or under-correction.

* Infection (rare).

* Later need for TKA (usually 8–10 years later).

🔹 Recovery Timeline

* Hospital stay: 2–4 days.

* Partial weight bearing with crutches: 4–6 weeks.

* Physiotherapy starts early to regain motion and strength.

* Return to desk work: 2–4 weeks.

* Sports/heavy activity: 4–6 months (depends on healing).