Osteotomy (high tibial and distal femoral)

High Tibial Osteotomy

High tibial osteotomy is a surgical procedure performed to relieve pressure on the damaged site of an arthritic knee joint. It is usually performed in arthritic conditions affecting only one side of your knee and the aim is to take pressure off the damaged area and shift it to the other side of your knee with healthy cartilage. During the surgery, your surgeon will remove or add a wedge of bone either below or above the knee joint depending on the site of arthritic damage.

High tibial osteotomy is commonly used for patients with osteoarthritis that is isolated to a single compartment (unicompartmental osteoarthritis). It is also performed for treating a variety of knee conditions such as gonarthrosis with varus or valgus malalignment, osteochondritis dissecans, osteonecrosis, posterolateral instability, and chondral resurfacing.


The goal of the surgery is to release the involved joint compartment by correcting the malalignment of the tibia and to maintain the joint line perpendicular to the mechanical axis of the leg.  There are two techniques that may be used: closing wedge osteotomy and opening wedge osteotomy.  The surgeon determines the choice of the technique based on the requirement of the patient.

Closing wedge osteotomy

Closing wedge osteotomy is the most commonly used technique to perform high tibial osteotomy. In this procedure, the surgeon makes an incision in front of the knee and removes a small wedge of bone from the upper part of the tibia or shin bone.  This manipulation brings the bones together and fills the space left by the removed bone. The surgeon then uses plates and screws to bind the bones together while the osteotomy heals.  This procedure unloads the pressure off the damaged joint area and helps to transfer some of the weight to the outer part of the knee, where the cartilage is still intact.

Opening wedge osteotomy

In this procedure, the surgeon makes an incision in front of the knee, just below the knee cap and makes a wedge-shaped cut in the bone. Bone graft is used to fill the space of the wedge-shaped opening and if required plates and screws can be attached to further support the surgical site during the healing process. This realignment increases the angle of the knee to relieve the painful symptoms.

Complications following high tibial osteotomy may include infection, skin necrosis, non-union (failure of the bones to heal), nerve injury, blood vessel injury, failure to correct the varus deformity, compartment syndrome and deep vein thrombosis or blood clots.

Distal Femoral Osteotomy

An osteotomy is a surgical procedure that involves cutting and reshaping of a bone. Distal femoral osteotomy is indicated to correct deformities and malalignments such as valgus knee, a deformity where the knee angles out from the center of the body. It is also performed to treat osteoarthritis in young active patients contraindicated for joint replacement.

Prior to the surgery, your surgeon orders a series of imaging studies to estimate the extent of deformity and calculate the degree of correction for correct alignment of your legs. Distal femoral osteotomy is performed under general or spinal anesthesia. A 4 to 6 cm incision is made in the upper leg near the knee from the side (laterally). The muscles and blood vessels are protected and the thigh bone is approached. Under fluoroscopy, a guide wire is inserted. With the help of an oscillating saw, a wedge-shaped bone is removed and a wedge-shaped instrument with markings is inserted to measure and confirm the bone gap’s dimension. The correct alignment of your leg is confirmed. The bone is secured with a TomoFix plate, a fixation device that provides stable fixation of the osteotomy. The plate is fixed to the bone with the help of screws. A wedge-shaped bone graft is removed from the pelvic bone and inserted to fill the osteotomy defect. Once the correct alignment of your leg is confirmed, the muscles and blood vessels are released and the incision is sutured.

As with all surgical procedures, distal femoral osteotomy may be associated with certain complications such as infection, blood clots, delayed or nonunion of the bone and injuries to the surrounding blood vessels.



HTO - iBalance System - meniscal transplant

  • The American Board of Orthopaedic Surgery Website
  • The American Orthopaedic Society for Sports Medicine Website