High tibial osteotomy is a surgery used to correct knee malalignment and reduce pressure on the worn part of the knee. It helps shift weight away from the damaged medial side of the knee to healthier areas. This can reduce pain and delay the progression of osteoarthritis in selected patients.
How Common It Is and Who Gets It? (Epidemiology)
High tibial osteotomy is most commonly used in younger, active individuals between the ages of forty and sixty. It is used when arthritis affects only the inner side of the knee and when the joint still moves well.
Why It Happens – Causes (Etiology and Pathophysiology)
Varus malalignment, also called bow-leg deformity, places too much force on the medial compartment of the knee. Over time this leads to cartilage wear, pain, and arthritis. High tibial osteotomy shifts the mechanical axis of the leg to reduce this overload.
How the Body Part Normally Works? (Relevant Anatomy)
The knee joint includes the thigh bone, shin bone, kneecap, cartilage, meniscus, ligaments, and synovial lining. When the leg is aligned normally, weight is shared evenly across the knee. When knees are malaligned, the cartilage and meniscus on one side wear down faster.
What You Might Feel – Symptoms (Clinical Presentation)
Common symptoms include pain along the inner side of the knee, stiffness, swelling, and difficulty with daily activities. Some patients feel grinding or popping and have trouble fully bending or straightening the knee.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis includes medical history, physical examination, and X-rays. Additional tests such as MRI or CT scans may be used to assess cartilage, ligaments, and bone structure. Alignment views and measurements such as the tibial bone varus angle help plan the correction.
Classification
High tibial osteotomy techniques include:
Medial opening wedge osteotomy.
Lateral closing wedge osteotomy.
Dome osteotomy.
These methods differ in how the bone is cut and realigned.
Other Problems That Can Feel Similar (Differential Diagnosis)
Symptoms may resemble meniscus tears, ligament injuries, inflammatory arthritis, patellofemoral arthritis, or more advanced osteoarthritis.
Treatment Options
Non-Surgical Care
Before surgery, symptoms may be managed with physical therapy, medications, bracing, injections, and lifestyle changes.
Surgical Care
High tibial osteotomy realigns the tibia to shift weight away from the damaged medial compartment. The correction angle is planned carefully to achieve slight valgus alignment, usually between three and five degrees.
Fixation Methods
The fixation method used in HTO plays a crucial role in the success of the procedure. Plate fixation is the most commonly used method, with options including spacer plates and locking compression plates (LCP). Spacer plates are small, low-profile implants that allow for a less invasive procedure but may be associated with complications such as delayed union or nonunion. In contrast, locking compression plates like the TomoFix plate offer more rigid fixation, allowing for earlier weight-bearing and faster recovery.
In some cases, bone grafts or substitute materials like hydroxyapatite or beta-tricalcium phosphate are used to promote healing and enhance stability. Studies have shown that the use of autograft (patients’ own bone tissue) yields better outcomes compared to allograft or synthetic materials, especially in patients at higher risk for nonunion, such as smokers and those with obesity.
Recovery and What to Expect After Treatment
Recovery time depends on the fixation method. With plate fixation, partial weight-bearing may begin immediately and full weight-bearing after two weeks. With spacer plates in opening wedge osteotomy, partial weight-bearing may be delayed for at least six weeks. Rehabilitation focuses on improving motion and strength.
Possible Risks or Side Effects (Complications)
Complications may include infection, delayed union, nonunion, nerve injury, or poor alignment. Removing too much or too little bone can create leg shortening or lengthening. The risk of complications increases in patients with advanced arthritis or ligament instability.
Long-Term Outlook (Prognosis)
High tibial osteotomy can improve knee function and reduce pain for many years. Ten-year survival rates range from fifty-one percent to ninety-three percent. Results are best in younger patients with mild to moderate arthritis and good alignment.
Out-of-Pocket Cost
Medicare
CPT Code 27457 – High Tibial Osteotomy: $226.71
Medicare usually covers most of the approved charge for this alignment procedure, leaving the patient with the standard twenty percent portion. Supplemental insurance plans such as Medigap, AARP, or Blue Cross Blue Shield typically remove that remaining share. These supplemental policies work alongside Medicare and are meant to fill the co-insurance gap, which often results in little or no remaining cost when the procedure is Medicare-approved.
Secondary insurance, including employer-based coverage, TRICARE, or the Veterans Health Administration, becomes the next payer after Medicare. Once any deductible is met — usually between $100 and $300 — the secondary plan may pay whatever balance remains. This often reduces or eliminates the remaining cost tied to the osteotomy.
Workers’ Compensation
If your knee condition requiring a high tibial osteotomy is linked to a work-related injury, Workers’ Compensation pays the full cost of the surgery and all related care. This leaves you with no out-of-pocket expense.
No-Fault Insurance
If the need for the osteotomy stems from a motor vehicle accident, No-Fault Insurance covers the entire procedure. Your only possible cost may be a small deductible depending on your specific policy.
Example
A patient needed a high tibial osteotomy to correct knee malalignment. Under Medicare, the estimated out-of-pocket cost was $226.71. Because the patient also carried secondary insurance, the remaining portion was covered fully, leaving the patient with no out-of-pocket expense.
Frequently Asked Questions (FAQ)
Q. Who is the ideal candidate?
A. Patients between forty and sixty with isolated medial compartment arthritis and varus alignment.
Q. How long is the recovery?
A. Recovery may take several months depending on bone healing and rehabilitation.
Q. Does it prevent knee replacement?
A. It delays the need for knee replacement but does not always prevent it.
Q. Will the bone always heal?
A. Most heal well, but delayed union or nonunion can occur.
Q. Can it treat other conditions?
A. It may also help in cases involving meniscal transplantation or isolated cartilage problems.
Summary and Takeaway
High tibial osteotomy is used to realign the leg and relieve stress on the worn inner part of the knee. It is most effective in younger, active individuals with mild to moderate osteoarthritis. Success depends on proper patient selection, precise correction, and good rehabilitation.
Clinical Insight and Recent Findings
A recent study comparing high tibial osteotomy performed with and without a tourniquet found that although tourniquet use reduced intraoperative bleeding and shortened operative time, it did not decrease total blood loss and was linked to higher postoperative pain, more swelling, elevated inflammatory markers, and slower early knee motion.
These findings complement your overview of high tibial osteotomy, reinforcing that the procedure’s success depends heavily on early rehabilitation, careful alignment correction, and minimizing postoperative inflammation.
By avoiding a tourniquet when modern bleeding-control methods such as tranexamic acid are used, surgeons may support faster recovery and better early function in the younger, active patients who typically undergo this joint-preserving surgery. (“Study of tourniquet use in high tibial osteotomy – See PubMed.”)
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons trained in knee alignment procedures perform high tibial osteotomy. The team includes anesthesiologists, nurses, and physical therapists.
When to See a Specialist?
A specialist should be consulted for ongoing knee pain located on the medial side of the knee, especially when accompanied by bow-leg alignment.
When to Go to the Emergency Room?
Emergency attention is needed for severe swelling, fever, uncontrolled pain, or signs of infection after surgery.
What Recovery Really Looks Like?
Patients begin motion exercises soon after surgery. Strength and mobility gradually improve. Full function returns over several months depending on the technique and healing rate.
What Happens If You Ignore It?
Ignoring malalignment may lead to worsening arthritis, increased pain, and progressive joint damage.
How to Prevent It?
Maintaining healthy weight, addressing injuries early, and protecting knee alignment may help protect the joint.
Nutrition and Bone or Joint Health
Healthy meals support bone healing. Adequate protein, hydration, and balanced nutrition assist recovery.
Activity and Lifestyle Modifications
Activity increases gradually with physical therapy guidance. Full weight-bearing begins when the bone has healed enough to tolerate stress.
Dr. Mo Athar
