What is it?

A high tibial osteotomy is a surgery that reshapes the upper shin bone to shift weight away from a damaged or arthritic part of the knee.

By realigning the knee joint, pressure is redistributed, which can reduce pain and slow joint wear.

It is most often performed in younger, active patients with arthritis that affects one side of the knee.

What happens when it occurs?

When joint wear is uneven, the leg may become slightly bowed or knock-kneed, which puts extra stress on one part of the joint.

This leads to pain, cartilage wear, and reduced mobility.

By cutting and repositioning the tibia, surgeons alter the line of weight bearing, allowing force to pass more evenly across the joint.

Common causes and risk factors

  • Osteoarthritis affecting one compartment of the knee
  • Previous meniscus injury or loss
  • Leg alignment that is bow-legged or knock-kneed
  • High activity levels on a stressed joint

Who is most affected?

Adults under sixty with isolated knee arthritis who are too young or too active for a total knee replacement.

Typical symptoms

  • Pain on one side of the knee during weight bearing
  • Stiffness and swelling after activity
  • A bowed leg appearance in medial arthritis
  • Difficulty with walking or standing for long periods

When to consider surgery

  • Ongoing pain despite non-surgical care
  • Localised arthritis in one side of the knee
  • Younger and active patients who wish to delay knee replacement
  • X-rays that show malalignment that contributes to symptoms

How surgery is performed

An osteotomy is performed on the upper tibia.

The bone is realigned, and the gap is either opened or closed to shift the weight-bearing axis.

Metal plates and screws hold the bone in place while it heals. A bone graft may be used if necessary.

Patients usually stay in the hospital for two to four days.

Rehabilitation after surgery

At Spinal and Sports Care, rehabilitation protects the healing bone while restoring motion and strength.

Early phase, zero to six weeks: partial weight bearing with crutches, controlled range of motion, and swelling control.

Intermediate phase, six to twelve weeks: gradual increase in weight bearing, strengthening for quadriceps, hamstrings, and hip muscles, and balance training.

Advanced phase, three to six months: functional training, stair work, and low-impact activity such as cycling.

Return to activity, six to twelve months: full strength and endurance training matched to work or sport needs.

Prevention of further joint damage

  • Weight management to reduce knee load
  • Regular exercise for strength and balance
  • Avoid repetitive high-impact activity

Latest insights

High tibial osteotomy can delay the need for knee replacement in younger patients.

Advances in surgical planning, three-dimensional imaging, and fixation plates have improved accuracy and outcomes.

Combining HTO with cartilage or meniscus restoration is becoming more common in selected cases.

Frequently Asked Questions

Timeframes depend on the procedure and your starting capacity. We progress when pain is controlled, swelling is down, and movement and strength targets are met. Expect a structured plan and criteria to guide you more than the calendar.

Yes, inside your plan. Keep pain during activity at or below 3 out of 10 and ensure it is no worse than the next morning. Use supports and aids as directed.

Imaging is used in conjunction with surgical decisions or when progress stalls. Your clinician will advise on whether an X-ray, ultrasound, CT scan, or MRI is most useful.

They protect healing tissue in early phases. We reduce support as control and strength improve, then remove them for strengthening and gait retraining. You will be guided by your surgeon and health care practitioner.

Ice helps early when swelling and pain dominate. Heat helps later when stiffness is the main issue.

If the pain is 2 out of 10 or less the next morning, swelling is stable, strength is within 90 per cent of the other side, and you pass your functional tests for the procedure.

Cut the next session’s volume by 20 to 30 per cent, keep your strength work, elevate and ice, then retest the following day.

Most people return in stages. Drive when you can load and move the knee safely and brake firmly without pain, and when medications do not impair you. Your clinician and surgeon will provide guidance.