High tibial osteotomy

Overload and degenerative changes of a knee joint medial compartment frequently happen to persons who have been active and doing sport as amateurs for many years. Common clinic patients are aged 40-50 and complain about pain in the knee joint. They are surprised because they never had any major difficulties with this and now need to deal with pain which prevents them from taking regular activities. When a conservative treatment, that is intensive rehabilitation and knee injections, does not bring positive results, a doctor chooses to perform a surgery.

Too considerable joint overload
Thanks to additional detailed tests – X-ray and magnetic resonance – it is possible to identify the cause of pain. Patients suffer from overloading and degenerative changes of the knee joint. A medial meniscus and joint cartilage are damaged. The tests show that these elements of the joint have been overloaded and degraded for a long time. It was the case because the joint axis disorder occurred as a result of a progressing joint ailment. Because of this, when a knee was loaded, forces were not distributed evenly and overburdened e.g. medial compartment.


Osteotomy – better solution for many
Today we know that advanced degenerative changes in the knee require joint replacement with implant (endoprosthesis). Joint replacement is a serious surgery which entails considerable risk and leads to limited physical abilities in the future. When pathological changes have not covered the entire joint, there is an alternative – surgical treatment which is supposed to postpone or replace this solution and let a patient do sport actively.

The treatment plan involves a knee joint arthroscopy and knee axis correction with the aim to distribute forces impacting the joint cartilage, and in particular support damaged elements of the joint. This surgery is referred to as high tibial osteotomy. Depending on the axis disorder (deviation or deformity), a relevant correction is performed. In arthroscopy, damaged elements of the joint, such as meniscus or cartilage, are repaired.

Bone correction
Osteotomy, that is a controlled bone incision. It is performed from the minor skin cut under the knee from the medial side. It allows safe exposure of a part of tibial bone. Once the correction angle has been carefully calculated (on the basis of X-ray) with the use of special instruments, a tibial bone is incised. When a specific axis correction has been achieved, the bone is combined with a special titanium stabilization plate. The entire procedure is subject to intraoperative X-ray control.

Three months before running
After the surgery the patient uses the knee joint orthosis and elbow crutches. Rehabilitation starts on the day that follows the surgery – at first walking exercises under the eye of a physiotherapist and improvement exercises. Joint movement exercises and muscle activation exercises are soon adopted as well. These two elements of the rehabilitation are key in the process of healing the joint. After six weeks the patient will be able to leave the crutches, and after a few months – be ready to take physical activities again.

High tibial osteonomy is dedicated to active patients who wish to avoid joint replacement or delay this implantation. It is intended for persons who suffer from overloading and degenerative changes, damage to cartilage and knee meniscus (frequently after prior removal).

High tibia osteotomy discussed by
Andrzej Pyda, a Rehasport Clinic orthopedist