Knee osteotomy (realignment surgery)
An osteotomy realigns the leg so that your weight passes through the healthier part of the knee instead of the worn part. It can relieve pain, let you stay active and delay the need for a knee replacement, often by many years.
How it works
Many people with arthritis on the inner side of the knee are slightly bow-legged, which concentrates load on the worn area. People with arthritis on the outer side are often knock-kneed. By making a precise cut in the bone and changing its angle, an osteotomy shifts the load onto the healthier side.
- High tibial osteotomy (HTO): the shin bone is realigned, usually for inner-side arthritis with bow legs
- Distal femoral osteotomy (DFO): the thigh bone is realigned, usually for outer-side arthritis with knock knees
The bone is held in its new position with a plate and screws while it heals.
Who is suitable?
- Active people, typically under around 65, with arthritis mainly on one side of the knee
- A knee that bends and straightens well
- Healthy ligaments, or ligaments that can be reconstructed at the same time
- Non-smokers, or people willing to stop, as smoking affects bone healing
Planning
Planning is precise. I use full-length standing X-rays of the leg to measure your alignment and calculate the correction for your knee. Often I will utilise CT imagery to create a 3D model and custom cutting apparatus in order to increase accuracy.
Recovery
| Hospital stay | Usually 1 night |
| 0 to 6 weeks | Crutches with partial weight-bearing while the bone heals |
| 6 to 12 weeks | Gradually walking without crutches, strengthening with physiotherapy |
| 3 to 6 months | Return to most activities, including cycling and swimming |
| 9 to 12 months | Final result; the plate can be removed later if it causes irritation |
Risks
Include infection, blood clots, delayed healing of the bone or failure to heal, loss of correction, irritation from the plate, and nerve or blood vessel injury. An osteotomy doesn’t prevent a knee replacement in the future, and a later replacement remains possible.
Osteotomy or partial knee replacement?
Both can treat arthritis on one side of the knee. An osteotomy keeps your own joint and places fewer restrictions on high-impact activity, but has a longer recovery. A partial replacement gives a quicker recovery but replaces the worn surface with an implant. I’ll talk through which suits your knee and your goals.
Frequently asked questions
How long does an osteotomy last?
Many people get benefit for 10 years or more, but it varies with the degree of arthritis and activity levels.
Can I go back to sport?
Many people return to hiking, cycling, skiing and gym work. High-impact running is discussed individually.
Will I need the plate removed?
Not usually. It’s removed only if it causes discomfort, typically after at least a year.