Q: What is the purpose of a high tibial osteotomy?
A high tibial osteotomy distributes the stress of weight bearing across the knee more evenly. It relieves excessive pressure on the diseased (or arthritic) side of the knee joint.
Q: What is the recovery time for a high tibial osteotomy?
3 weeks of nil weight bearing, followed by six weeks of minimal weight bearing with crutches and 12 weeks of rehabilitation with physical therapy. Most patients are able to recover to full activity by six months.
Q: What evaluation do I need before a high tibial osteotomy?
You will need full length x-rays and a physical examination.
Q: Is total knee replacement surgery difficult after an HTO procedure?
Total knee replacement surgery is very much possible after an HTO. The only difference is that it becomes a more difficult surgery as compared to a primary total knee replacement surgery. Also it involves the removal of plate and screws put earlier in the tibia for the union of the HTO. This can be done as a first stage surgery followed by a knee replacement or both procedures can be done in the same sitting.
Q: Is osteototmy more painful than total knee replacement?
No, there is no difference in pain and patients after both surgeries become painless in about 3 weeks.
Q: What are the long term results of High Tibial Osteotomy?
This knee surgery is indicated for young people with arthritis of the knee and is often used as a stop gap operation to delay joint replacement. Various studies have shown that majority of the pain can be relieved for up to 10 years but after that period a knee replacement is often required. Performing a high tibial osteotomy avoids the risks of putting an artificial knee joint in a young patient which may need to be changed after 10-15 years. The restrictions on the activity following a high tibial osteotomy are also often less than that following a knee replacement.
Q: If this procedure is so good, why is it that it is not popular and how come not many surgeons advise about it?
Since the results depend on accuracy of correction, the ability to correct deformities accurately within one or two degrees of normalcy is a skill not developed in surgeons in general. Hence this operation is performed only by those few who have great expertise as well as a special fondness for this procedure.
Also as the implants used are not very expensive, there is no industry backing to market this procedure.
However, this operation is the best for young patients with osteoarthritis involving only one compartment.