What Is High Tibial Osteotomy?
High Tibial Osteotomy is a surgical procedure performed to correct deformities in the upper part of the tibia (shinbone). Structural deformities or those resulting from excessive physical activity can develop over time in the tibia, leading to knee and anterior leg pain. In these patients, the center of gravity shifts toward the inner side of the knee instead of passing through the center of the knee, potentially causing early wear and tear on the joint. During the high tibial osteotomy, the deformity is corrected by cutting the bone and repositioning it according to a predetermined plan.
Who Is a Candidate for High Tibial Osteotomy?
High tibial osteotomy is particularly suitable for individuals described as having “O legs,” where the knees do not touch when standing with their heels together. However, having “O legs” alone does not guarantee eligibility for surgery; the presence of knee or anterior leg pain, or experiencing pain earlier and more intensely during activities, is also required. Candidates are generally younger individuals (under 50-55 years old) with a history of sports or physically demanding jobs. Early signs of degeneration in the knees and/or accompanying meniscus tears may also be present.
High tibial osteotomy can serve as a salvaging surgery after repeated anterior or posterior cruciate ligament ruptures. It is especially recommended for patients with anterior cruciate ligament injuries, along with existing O leg deformities, to ensure the success of the ACL surgery.
During the examination, an X-ray may be taken to show the alignment of the knee. This will help assess the degree of deformity. Typically, an MRI is also performed to check for associated cartilage, ligament, or meniscus injuries, which can be addressed during the same session if needed.
Pre-Operative Care
Once the surgery is planned, the patient’s current medications, especially anticoagulants, need to be adjusted accordingly. Smoking cessation is advised, as it negatively affects bone healing. An anesthesiologist will evaluate the patient and determine the appropriate method of anesthesia, which may be spinal anesthesia (numbing the lower body) or general anesthesia (complete unconsciousness). Patients will need to fast for about 6-8 hours before the surgery.
During the Surgery
Prior to the surgery, the doctor calculates the incision site and correction amount using special programs or templates from X-rays. A 5-7 cm incision is made on the inner side just below the knee, where the bone cut is guided by fluoroscopy (a mobile X-ray tool in the operating room). The deformity at the top of the tibia is corrected using specialized tools, and its accuracy is confirmed during the procedure. The corrected bone is stabilized using specially designed plates and screws, and the skin is then closed appropriately.
Post-Operative Care
After surgery, medications will be administered intravenously to manage pain. Mobility exercises for the knee will begin on the first day post-surgery. Patients are encouraged to bear weight on their leg with the aid of crutches as tolerated. To prevent swelling, cold applications are recommended for the first 15 days, along with exercises to strengthen the quadriceps muscle.
Generally, patients can drive after about three weeks and resume daily activities with a single support after about a month. Bone healing typically occurs around the second month, allowing patients to return to normal activities after this period. By the third month, patients can engage in light activities such as jogging and swimming, while more strenuous sports like basketball and soccer can be resumed by the sixth month.
Risks of Surgery
As with any surgery, complications such as infection and bleeding can occur after high tibial osteotomy. To prevent these complications, antibiotics will be administered pre-operatively, and medications may be adjusted as needed. Since it involves a bone cut, there is a risk of non-union, particularly in smokers. In cases of unilateral deformity correction, there may be a leg length discrepancy of up to 1 cm, but this is usually not problematic in daily life. The doctor may suggest small lifts in the other shoe if necessary.
Some patients may experience discomfort from the thin-profile plate placed on the inner side of the knee. If this occurs, the plate can be removed in a simple procedure 6-8 months after surgery.
Other specific risks related to your overall medical condition, illnesses, and medications will be discussed by your doctor.
Outcomes
For patients with knee alignment issues, these deformities can adversely affect the distribution of load on the knee joint, leading to early osteoarthritis. Structures within the inner side of the knee, including cartilage and menisci, may wear down and become damaged more quickly. High tibial osteotomy can correct this alignment and load distribution early on, allowing patients to use their own knees for many years without requiring additional interventions or prosthetics. Patient satisfaction with the surgery is generally high in the long term.
Questions and Answers
I have O leg deformities in my legs, but could this deformity originate from something other than the tibia?
Many leg alignment issues originate from the tibia, but deformities can also arise from the femur (thigh bone) or the knee joint itself. When deformities are caused by the knee joint, prosthetics may be more commonly considered, while femur-related deformities can be addressed with osteotomy similar to tibial procedures.
I am overweight and have O leg deformities. Can I still have surgery?
This decision should be made in consultation with your doctor. However, overweight patients may have a higher risk of wound issues and potential loss of correction due to weight.
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