Treating Painful Knees via High Tibial Osteotomy Surgery

In many persons, misaligned knees can lead to debilitating pain, restricting function and mobility. In such cases, two surgical avenues are available for addressing this problem: realignment osteotomies and joint replacements. In certain patients, particularly the youth(given their age and activity levels), realignment osteotomies – viz., high tibial osteotomy (HTO) – are an appropriate option.

Introduced in 1958, HTO was first used in correcting primary knee deformities and, later, in treating osteoarthritis of the knee. HTO may be recommended for people with painful arthritic knees and/or unstable knee joints. Osteotomy refers to cutting and reshaping a bone so it’s aligned with a joint. In knee osteotomies, the cuts are usually in the top of the tibia, therefore the term ‘high tibial osteotomy’. 

When some patients suffer arthritis (thinning or damage to the cartilage/meniscus) or instability (giving away or buckling of the knee due to ligament damage), their condition can be improved by realigning the knee. High Tibial Osteotomy surgery can prevent or delay the need for either partial or total knee replacement because it helps preserve damaged joint tissue.

Some elaboration is necessary on how the knee functions. When you take a single step, a force equivalent to three to eight times the body weight travels between your femur (thighbone) and tibia (shin bone) in the knee. Two menisci located on the inner and outer knee then soften these forces even as the bone ends remain shielded by articular cartilage.

But patients with osteoarthritis (or degenerative arthritis) of the knee are subjected to successive wear-outof the menisci and articular cartilage, which may later develop tears. As these tissues degenerate, the ability of the knee in gliding smoothly is limited, resulting in catching, clicking, popping, locking and pain. In such a condition – called mal-alignment – the unbalanced forces exert excessive pressure on either the inner (medial) or outer (lateral) part of the knee. In a repetitive damage cycle due to degenerative arthritis and mal-alignment, the protective tissues of the knee wear out more on one side than the other.

If the knee joint is damaged beyond repair, your orthopaedic surgeon may recommend knee replacement surgery. In some cases, however, a high tibial osteotomy will be better in relieving pressure on the damaged side by reconfiguring the knee joint. Weight-bearing is then shifted onto the healthier tissue from the damaged/worn tissue. Since HTO benefits only last for about a decade or so, it is typically considered when a young patient seeks to postpone knee replacement for as long as possible.

Ultimately, however, this surgery can be beneficial for young patients because there are no activity restrictions after a person recovers completely from the HTO procedure, which can take up to a year.