What is it?

When the bones of your knee and leg do not line up properly this can put extra stress on your knee. Over time, this extra pressure can wear away the smooth cartilage that protects the bones, causing pain and stiffness in your knee.

Osteotomy literally means “cutting of the bone”. In a high tibial osteotomy, the tibia (shinbone) is cut and then realigned to relieve pressure on the knee joint, which can relieve pain and significantly improve function.

Is surgery required?

Studies show that a High Tibial Osteotomy can provide good pain relief whilst allowing one to maintain all activities (including sports) for an average of 7-10 years. Therefore it can delay the need for a knee replacement.

How is it done?

The tibia is cut just below the knee joint on the side with more pain (the medial side). The surgeon straightens the leg according to the degrees/size carefully calculated and measured on your pre-operative xray’s. The tibia is fixed in this new position with a plate and screws. This distributes the load/weight on the knee more evenly AND unloads the painful side.

Will it work?

Osteotomy can relieve pain and delay the progression of arthritis in the knee. It can allow a younger patient to lead a more active lifestyle for many years.

It takes most patients about 6 months to fully recover form high tibial osteotomy.

For more information about your condition, go to: www.orthoinfo.aaos.org –  click on “Knee & Lower Leg”

HIGH TIBIAL OSTEOTOMY

Instructions for AFTER the surgery

Walking

  • You may put full weight on your leg BUT you must use crutches
  • Bend and straighten your knee as much as you can

Bandaging

  • All wounds are closed with “dissolving” stitches AND covered with a WATERPROOF dressing.
  • Leave bulky dressing undisturbed for 48 hours.
  • Remove bulky dressing after 48 hours and replace with elastic bandage (Tubigrip) supplied.
  • Wear elastic bandage at all times except for daily shower. (NO soaking, baths or swimming yet).

What to expect

  • Swelling. This is to be expected. Try to rest with the leg fully straight. A pillow under the heel will help with this. DO NOT REST WITH A PILLOW UNDER THE KNEE. Elevate the leg on a pillow or cushion while sitting. An ice pack can be used.
  • Pain. You will receive a prescription for pain medication on discharge. These tablets work best if taken regularly, esp during the first week or two.
  • Possible temporary numbness and/or tingling around the wound site. This will get better by itself over time.

Exercises

  • The Hospital Physiotherapist will provide you with information/ instructions of exercises to do.

Unexpected Symptoms/Signs

  • Excessive persistent pain
  • Pus discharge from wound
  • Fever
  • Excessive pain AND tenderness AND swelling in the calf.

Should any of these symptoms persist contact Dr Sim’s rooms or after hours emergency.

High Tibial Osteotomy Rehab Protocol

Stage 1

Wound Healing and Weight Bearing

0-2 WEEKS

0-6 WEEKS

Goals

  • Use crutches appropriately
  • Decrease pain and swelling
  • Ensure wound is healing
  • Quadriceps activation
  • Gait retraining
  • Achieve 0-90 Active ROM

Gait

  • Protected weight bearing (i.e. full weight bear but must use crutches at all times)

Range of Motion (ROM) and Flexibility

  • You will be shown exercises by hospital physiotherapist prior to discharge

Stage 2

Strengthening

(MUST BE GUIDED/SUPERVISED by physio)

6-12 WEEKS

Goals

  • Normal gait without walking aids (i.e. walking without a limp)
  • Full and pain free knee range of motion

Exercise Suggestions

Hydrotherapy / Pool

  • Knee ROM
  • Walking forward/backward, static lunge, lunge walking, squats, side shuffles, step up/down, calf raises (2-1 foot)
  • Hip extension/flexion, adduction/abduction

Cardiovascular Fitness

  • Stationary bike
  • Treadmill – walking

Driving

You can consider driving if:

  • You are off strong prescription pain killer (Endone)
  • You are OFF your crutches
  • You have GOOD leg control (e.g. you are able to stimulate an emergency braking manouvre in a stationary car without any PAIN in the knee)

9-12 WEEKS

Goals

  • Continue flexibility/stretching exercises
  • Quadriceps strength progression

Exercise Suggestions

Hydrotherapy / Pool

  • Increase time, speed, repetitions of exercises

Cardiovascular Fitness

  • Bike – increased resistance and time parameters
  • Treadmill – walk

Stage 3

Return to Activity

4-6 MONTHS

Goals

  • Continue with advanced strengthening
  • Progress with cardiovascular conditioning.

Exercise Suggestions

Muscle Strength & Endurance

  • Quadriceps
  • Hamstrings
  • Calves

Cardiovascular Fitness

  • Bike
  • Treadmill
  • Swimming or pool running

Stage 4

Return to Sport

6+ MONTHS

Return to impact sports eg. Running, jumping once cleared by Dr Sim and physiotherapist