High Tibial Osteotomy
Also called the shinbone, the tibia connects the knee with the bones of the ankle. The tibia and fibula make up the leg below the knee and bears the weight of the body. A high tibial osteotomy involves cutting the proximal tibia to change the alignment of the knee. Knee surgeons perform high tibial osteotomies to increase knee stability and improve effects of knee arthritis. Surgeons may perform a high tibial osteotomy to delay a patients need for a knee replacement.
High Tibial Osteotomy over Total Knee Arthroplasty
Surgeons may utilize high tibial osteotomies to give the patient roughly 10 extra years before needing a partial knee or a total knee replacement. Surgeons may perform a high tibial osteotomy in addition to other procedures with the goal of knee preservation. For example, the MACI procedure which regrows cartilage. Preservation procedures often aim to regrow damaged cartilage or take weight and pressure off of the arthritic and damaged area(s).
How surgeons perform a high tibial osteotomy
Surgeons perform high tibial osteotomies with the patient under general anesthesia. With a patient under general anesthesia, the patient remains asleep for the duration of the surgery. To start the surgery, the surgeon makes an incision on the medial knee and cuts into the tibia. The surgeon then makes the appropriate change in alignment. Utilizing a plate and metal wedge, the surgeon fixes the area with screws and inserts the chosen bone graft. Ideally the bone graft comes from the patients own tissue. For a high tibial osteotomy, the autograft typically comes from the pelvis of the patient. Using the patients own tissue for the graft helps the bone heal quicker and decreases the chances of the body rejecting the graft.
Recovering from a high tibial osteotomy
To manage pain, the patient likely stays in the hospital for one to two nights. Patients utilize a brace and crutches for 9-12 weeks following a high tibial osteotomy, gradually increasing the weight allowed on the surgical leg with the instructions of the treating physician. The surgeon prescribes a physical therapy protocol for the patient to follow following surgery. Even before adding weight on the surgical leg, the patient participates in a passive physical therapy program to ensure they do not lose mobility of the knee.