Overview
When a younger, active patient has arthritis limited to one side of the knee — usually medial — and their leg bows into varus, the damaged compartment is overloaded with every step. Replacing the knee would work, but a joint replacement has a finite lifespan in a demanding patient. Realigning the tibia shifts load off the worn compartment and preserves the native joint.
How the Procedure Works
The correction angle is calculated preoperatively from standing long-leg X-rays — we aim to shift the mechanical axis from the worn compartment to a point just lateral to the center of the joint, typically to 62–66% across the tibial plateau. Under-correction leaves the patient with residual pain; over-correction unloads the repaired compartment but overloads the opposite one. We use a medial opening-wedge technique in most cases: a transverse cut is made in the proximal tibia, the wedge is opened to the planned angle under fluoroscopy, filled with bone graft or substitute, and held with a locking plate. The lateral cortex is left partially intact as a hinge — maintaining that hinge prevents the osteotomy from collapsing before it heals. Patients are protected with partial weight-bearing while the bone consolidates.
When to Consider High Tibial Osteotomy
High tibial osteotomy is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:
Unicompartmental arthritis with malalignment
Isolated medial or lateral compartment wear, matched to a varus or valgus leg axis on standing X-rays.
Active patient preserving a native knee
Patients who want to keep running, hiking, or doing physical work that would stress a knee replacement.
Preserved motion and ligaments
A knee with good range of motion and intact cruciate and collateral ligaments.
Conditions This Treats
Physicians Who Perform High Tibial Osteotomy
Providers Who Surgically Assist with High Tibial Osteotomy
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes continued overload of the worn compartment and progression toward end-stage arthritis that would force an earlier joint replacement. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before high tibial osteotomy include:
- bleeding and infection
- anesthesia risk
- non-union or delayed union at the osteotomy site
- hardware irritation
- under- or over-correction of alignment
- stiffness
- blood clot (DVT/PE)
- rarely, neurovascular injury near the proximal tibia
The indication to proceed is a younger, active patient with single-compartment wear and varus (or valgus) malalignment who is not yet a replacement candidate. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: