High Tibial Osteotomy

Does anyone have any experience good or bad on the outcomes and post operative recovery for High Tibial Osteotomy?

It's not me but my OH who has been advised that the athritic condition of his knee warrants such a procedure.  Obviously we'd discuss this with the consultant pre-op but would like to get as much info as possible to try to make as informed a decision as possible.  OH had been a runner for many years but had to stop due to bad knee pain 18 months ago.  Our main focus has always been mountain sports - fell running/trail running, fell walking, mountaineering, MTB-ing and he has been unable to participate for the past 18 months as he is limited to short flat walks though he can still cycle.

To me this is a particularly brutal and invasive procedure  - though if all goes well the consultant expects OH would get up to 15 years out of it before needing a full knee replacement.  The trouble is OH has this vision of us out running together on the fells in 6 - 8 months time.  He is reasonably realistic in that he says he would be happy just to be able to do 4 - 6 mile runs and I understand the need to have a positive mental attitude to the operation and to visualise a positive outcome at the end of it but does anyone have any experience of whether his aspirations are realistic or not?

The choices are stark - 1 Do nothing yet and take pain killers.  2 Be fitted for a knee brace and see how it goes (OH is dead set against this) 3. Surgical intervention with an HTO.  He is too young to be offered a full knee replacement and would not be able to run on one anyway.

So if anyone has any good or bad information or any consultants/physio out there I'd really appreciate it.

Knee brace

This is the type of knee brace he would need Mr P - it's not for running in - though I wouldn't put it past him trying!  He feels that surgery is the best option for him to be as active as he wants to be.  He has worn less obtrusive knee braces but now they do not help anymore.  He thinks that surgery will be necessary anyway even if he went for the brace now - it is just putting off the inevitable.  I'm just a little more conservative in my opinion of how it will be post-op.  It takes up to a year to recover and if you go down the route of breaking a weight bearing bone to reallign your leg - thats pretty traumatic.  I know that bones can knit together stronger than they were before a break - but does that still hold true when you are in your 50's? I don't know....... .  Ultimately he will do as he feels is right and I will support him 100% either way but I'm not sure what I'd do in his position it's not an easy decision.

HMmmmmmm- I'm a surgeon- not an orthopod, though, so can't directly answer the question, but surely if the brace has the chance of delaying the need forsurgery, that's worth a try.

The HTO will obviously change the alignment of entire lower leg- this is bound to affect running style, and will add to the time taken to get back to running after, I think.

Re; bone healing- an ective man in his 50's should be OK- different if post- menopausal female, and/ or smoker

A good additional source of info about post op activity/ return to running might be the physio's that work with this surgeon- I bet they see the patients much more frequently than the surgeon in  the post op period.

I am two years post op from a tibial osteotomy (I'm 53 years old) . I'm back to running now. My last 5k was 20:30. I'm hoping to qulify for the Boston Marathon this year. My longest run has been 17 miles at an 8:00 min pace.

Thats great Rick.  OH had the procedure in May last year.  He has recovered well but is not running.  We are back to long days out on the hill walking, he cycles about 140 miles a week and swims. He is wary of running as the consultant was cautious - this is not a cure it is merely a stopgap before the inevitable knee replacement and what you do with the repair post-op dictates to how long it will be before the replacement. We both realise everyone is different and nothing is set in stone though. OH is still looking to begin running again but probably only ever up to about 6 miles off road.  I think he is just so happy to be pain free (mostly).  Did you have the metal plate removed or have you left it in? 

Tigerlily...I had the plate removed after one year. I didn't start to run until it was out.  I highly recommend removing it. The key to running again is to strengthen the quads, calfs, and hams in BOTH legs. This requires a lot of work, but it’s worth it. Also, tell your OH to go to his surgeon before he starts to run and do two things. 1) get a synvisc injection. This will keep the knee lubricated. 2) Have his surgeon take an x-ray of the meniscus on his good compartment. The surgeon can blow up the image and get a good measurement on the thickness of it. Go back in 6 month intervals to get it x-ray'd again and compare it to the previous x-ray. This will determine how quickly the meniscus is wearing out and if you should back off from running. If you want any more info, feel free to contact me at runman888@aol.com.

Thanks for your input Rick.  I will certainly pass this on to OH.