High Tibial Osteotomy

Fact finding....

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24/12/2011 at 08:56

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.

24/12/2011 at 10:23
I don't know anything about this, but I hope you can resolve it TL. What's the objection to a knee brace? Would it be some sort of permanent attachment then?
24/12/2011 at 10:41

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.

24/12/2011 at 15:46

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.

24/12/2011 at 21:54
Thanks for that TC - the brace isn't an option he wants to go down simply because the sort of brace he'd need he couldn't run in anyway. The new leg alignment should actually correct his gait - he is very bandy legged on the left due to the collapse of his knee.

The thing is that his right leg is also affected by arthritis - not to the same extent as the left currently but I suspect 18 months down the line the right one will need doing too!

My main concern is that he could go through this and either be worse off or still unable to do the hillwalking and bit of running that he aspires to do.
20/02/2013 at 20:33

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.

21/02/2013 at 18:26

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? 

21/02/2013 at 18:42

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.

22/02/2013 at 06:14

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

08/10/2014 at 21:47

Hi Tigerlily, how's the OH's osteotomy holding up? I'm to have one on the 23rd of this month, currently have mixed feelings. Haven't run for a long time after a meniscus shave a few years back. I can cycle 30 - 40 miles, leg press 200 kg no problem but walking after sitting in the office is becoming painful. i don't mind the old if it's going to improve things and I'm prepared for the long recovery period but my greatest fear is not being able to cycle or get out walking on the hills etc. any feedback would be appreciated.

17/10/2014 at 11:30

Hi Gonzaleomez, I am 6 weeks post HTO and off to the surgeon on Monday to see if I’m ok to ditch the crutches...  I did Japan Ironman 2 weeks before the procedure so was in pretty good shape, albeit running with a lot of pain… I’m also keen to hear from Tigerlily to see how OH's osteotomy is holding up... but to give you a bit on my experience so far, the first week was quite uncomfortable but I have pushed through with the stretching and exercises and physio all the way till now, I have no pain at all it just feels stiff and restricted, my leg muscles really wasted away so It’s back to the gym for me to get my riding legs back. All in all, I also feared not being able run again, but, I do not regret getting the HTO, and feel very confident I will be back riding/running very soon…

18/10/2014 at 10:00

Hi Grinder 2, thanks for the update. i'm expecting 8 wks on the crutches. It would be good to hear from Tigerlilly or someone else to hear how things hold up longer term.i think the key to good recovery is having discipline to adhere to the stretching and excersises the physio prescribes in the first few months. have you had any indication as to how long you be off the bike? i'm going to get some entries in for a few sportives for early summer next year which hopefully give me some focus to stick to he recovery plan. I'm not looking forwad to losing leg muscle as I've always had good leg muscle from 20yrs + of front row rugby, but hopefully so dedication in the gym will bring that back. Hope your recovery goes well, please keep me posted as things progress it will be good to have a benchmark know what to expect as the weeks pass. 

22/10/2014 at 02:30

Gonzaleomez, I went to visit the surgeon on Monday and I am free to come off the crutches (week 6), his plan is that I need to continue with stretching and exercises and can start on a stationary bike in four weeks (week 10) and built to full impact running / riding in 8 weeks (week 14). I’m going to the Physio tonight to start working on the rehab plan… good luck with the Op tomorrow.

22/10/2014 at 21:50

Hi Grinder 2, It sounds like your recovery is going well. My op has been rescheduled for 13th November. keep me updated on your progress.

17/11/2014 at 12:21

Hi Grinder2  back home after the op last thursady. Everythings a bit stiff and sore but the op went well. Stumbled twice yesterday and put a bit of weight on the foot , hurt like mad, but all appears Ok. Not looking forward to the next 6 weeks but there's no option so have to man up and get on with it. How are things going for you?

25/11/2014 at 05:16

Hi Gonzaleomez.  Yes the first 6 weeks were very frustrating for me too; 11 weeks post Op now and all going well... I have been having some issues with muscle and tendon soreness but my physio says it’s normal as the body adjusts to the changes and I will be getting some “tendon over use” pain until my muscles totally recover… I started back on the bike last week (Albeit very slowly) and will continue with some fluid trainer work for a month or so before hitting the road, I still have about 10% less flexibility then my other leg… This is going to take time and I am not going to rush it, just going to continue with the program; Hang in there and make it worth the effort…. Good luck...

30/11/2014 at 21:36

Hi Grinder 2, got the first 2 weeks out of the way and feeling much better, swellings nearly all gone, flexibility is really good and to be honest i feel like i could ditch the brace now, but obviously can't. had first physio last week, just a few stretching excercises. the only soreness i have is around the back of the and heal most likely muscle and tendon. goning to hit the gym next week to do some light upperbody aerobic exercises to keep things ticking over. i'm under no illusions that there's a long way to go but things are good at the moment.....good luck for when you get back on the road, let me know how that goes.   

15/01/2015 at 16:42

24 weeks post op for me , age 48, have completed 230Km bike ride and a few easy 10km jogs, knee improving all the time. Make sure you are down to minimum weight and as fit as you can be before Op, and be patient when recovering .

15/01/2015 at 20:56

That's good news Dr Wiggins, i'm now 9 weeks post op and pain free with almost 100% flexbility/range of motion. still using crutches for stability, i can get around without them and put 80 - 90% weight on the leg. Just set up the turbo trainer tonight will have a 1o min spin in the morning. the physio reckons about 6 more weeks before i can start to get back on the road bike. biggest issue is going to be losing some weight, i need to drop 2 stone or so which is doable but willtake some time. my consultant reckons i won't run again, i'd like to prove him wrong if only to do the local park run on soft ground. thanks for your update it's always good to hear of peoples positive progress.


18/09/2015 at 16:38

Hi - I'm hoping some peopel who have contributed to this thread may be able to help with some advice.

I had an arthroscopy to remove some toen meniscus 8 months ago following severe knee pain after a run. Unfortunately this has had no impact and the pain continues to get worse.

Following a SPECT CT scan my surgeon is recommending an HTO - of course I'm not keen as I have two children and my own business so anything as incapacitating as an HTO is unwelcome.

I had some basic q's for starters:

How long are you unable to drive?

How long should you stay away from public transport?

How does the leg look after the op? I've heard the change in angle can look quite extreme...

How quickly could you return to working even if that's at home?

Prob lots more q's but any help with the above would be hugely appreciated.


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