What is a high tibial osteotomy?

The idea behind the operation

In a straight leg, body weight passes roughly through the centre of the knee. In a bow-legged (varus) leg, the weight line falls towards the inner side, so the cartilage and meniscus there carry more load with every step. Over years, that can wear the inner compartment while the outer side stays healthy.

A high tibial osteotomy (HTO) corrects the alignment of the leg so that load is shared more evenly, or moved slightly towards the healthy outer compartment. The aim is to reduce pain and slow further wear, not to replace anything.

How it is done

The most common technique is a medial opening wedge osteotomy. Through an incision on the inner side of the upper shin, a controlled cut is made in the bone, which is then gently opened to a planned angle. The gap is held with a strong metal plate and screws, and the bone heals across it over the following months, sometimes with bone graft or graft substitute.

An alternative is a lateral closing wedge, where a small wedge of bone is removed from the outer side. When a knee is knock-kneed rather than bow-legged, the correction is usually done on the thigh bone instead, called a distal femoral osteotomy.

Who it is usually for

• Pain mainly on the inner side of the knee
• Bow-legged alignment confirmed on a full-length standing X-ray
• A healthy outer compartment and kneecap joint
• Good range of movement and stable ligaments
• Usually younger and active patients, often in their 30s to 50s

It is sometimes combined with other procedures such as cartilage restoration, meniscal root repair or ligament reconstruction, so that the repaired tissue is not overloaded.

Planning in Doha

Accurate planning is central to a good osteotomy. At Aman Hospital, Dr. Gelber assesses the whole leg, measures alignment on long-leg X-rays and usually reviews an MRI to check the cartilage, meniscus and ligaments before calculating the correction.