Am I too old or too heavy for a high tibial osteotomy?

Age: biology matters more than the number

Osteotomy relies on bone healing and on cartilage in the outer part of the knee still being healthy. These tend to be better in people in their thirties to fifties, and the operation is most often offered in that range. A fit, active person in their early sixties may still be considered, while someone younger with widespread arthritis may not. The decision comes from examination and imaging, not age alone.

Weight

Higher body weight increases load on the knee and on the healing bone and plate, and is linked with less durable results. It does not automatically rule out surgery, but your surgeon may suggest working on weight first, sometimes with help from a dietitian or your physician. Even modest weight loss reduces knee load and can improve outcomes whichever treatment you have.

Other factors that change the picture

• Smoking slows bone healing and raises the risk of delayed union, so stopping before surgery is strongly advised
• Diabetes should be well controlled to reduce infection and healing problems
• Osteoporosis or low bone quality may make fixation less secure
• Arthritis in the kneecap joint or outer compartment reduces the benefit
• A stiff knee that cannot straighten or bend well is less suited
• Inflammatory arthritis, such as rheumatoid, is generally not treated with osteotomy

If osteotomy is not right for you

That is not the end of the road. Depending on the pattern of wear, options include physiotherapy, an unloader brace, injections for flare-ups, partial knee replacement or total knee replacement. At a consultation in Doha, Dr. Gelber explains which option fits your knee, your health and your goals.