High Tibial Osteotomy Knee Surgery

High Tibial Osteotomy Surgery Meaning

High tibial osteotomy (HTO) is a surgical procedure that realigns the knee joint to improve pain and function in people with unicompartmental (one-sided) knee arthritis. The goal of HTO is to offload the damaged area of the knee joint by shifting weight-bearing stress to the healthier side of the joint. This can delay or prevent the need for a total knee replacement.

There are two main technique of high tibial osteotomy (HTO) surgery:

1. Opening Wedge Osteotomy (OWO)

• An opening wedge osteotomy (OWO) is the most common type of HTO. 

• In an opening wedge osteotomy, a wedge-shaped bone graft (often taken from the patient's pelvis) is inserted into the opening created in the tibia.

• This procedure involves deliberately creating a gap in the tibia and then inserting the bone graft to realign the knee joint.

• Opening wedge osteotomy is often preferred when more correction is needed.

 2. Closing wedge osteotomy (CWO)

• A closing wedge osteotomy (CWO) is less common than an OWO. 

• In this technique, a wedge-shaped piece of bone is removed from the upper part of the shinbone (tibia).

• The remaining bone is then brought together and stabilized with plates and screws to correct the alignment of the knee joint.

There are a few other techniques that may be used for HTO, including:

3. Dome osteotomy

• In dome osteotomy, a semi-circular dome-shaped cut is made in the tibia.

• The cut section of the bone is then elevated or depressed to achieve the desired realignment.

• This technique is less common than closing or opening wedge osteotomies but may be used in specific cases.

 4. Progressive Callus Distraction

• Also known as distraction osteogenesis or Ilizarov method, is a surgical technique used to lengthen or correct bone deformities. 

• It involves gradually separating two ends of a bone using external fixators, which are metal frames that extend beyond the ends of the bone. 

• The distraction process stimulates the formation of new bone tissue between the separated ends, which eventually bridges the gap and joins the two ends of the bone.

The specific steps of the HTO surgical technique will vary depending on the type of surgery being performed. However, the general steps are as follows:

1. Anesthesia: The patient will be given general anesthesia or regional anesthesia to block the pain.

2. Incision: The surgeon will make an incision over the knee joint.

3. Expose the tibia: The surgeon will expose the tibia, the large bone in the lower leg.

4. Make the osteotomy: The surgeon will make a cut in the tibia to create the wedge-shaped opening.

5. Insert the bone graft (OWO only): If an OWO is being performed, the surgeon will insert a bone graft into the wedge-shaped opening.

6. Fix the osteotomy: The surgeon will use screws or plates to fix the osteotomy in place.

7. Close the incision: The surgeon will close the incision with sutures or staples.

Side Effects of High Tibial Osteotomy Surgery

High tibial osteotomy (HTO) surgery can have several side effects, including: 

• Injuries: Injuries to the peroneal nerve, tibial fracture, or detachment of extensor muscles

• Infection: Infection, deep infection, or hardware failure

• Other complications: Hematoma, thrombosis, delayed or non-healing of the osteotomy, pain from the metal plate, or hardware irritation

Other disadvantages of HTO surgery include: 

• The need for fibular osteotomy or the separation of the proximal tibiofibular joint

• Large corrections may compromise later placement of the tibial component during total knee replacement (TKR)

High Tibial Osteotomy Surgery Benefits

HTO can provide several benefits, including:

• Reduced pain and improved function

• Delayed or prevented need for a total knee replacement

• Preserved joint motion

• Improved quality of life

• Minimal Bone Removal

• Potential for Return to Sports

Who is a candidate for HTO?

HTO is typically considered for people who:

• Have unicompartmental knee arthritis that is not responding to non-surgical treatments, such as physical therapy, medication, or injections.

• Are between the ages of 40 and 60.

• Have a varus deformity, which means that their knees are knocked inward.

• Have good range of motion in their knee.

• Are not overweight or obese.

• Are active and want to maintain their lifestyle.

Here is a general overview of the HTO recovery timeline:

• Days 1-2: Most patients will be able to go home from the hospital the same day or the day after surgery. They will need to rest and elevation their leg.

• Weeks 1-4: Patients will need to use crutches or a walker to keep weight off their legs. They will also begin physical therapy to regain their range of motion and strength.

• Weeks 4-8: Patients will be able to gradually put more weight on their leg and start weaning off of their crutches or walker. They will continue with physical therapy.

• Weeks 8-12: Most patients will be able to return to their normal activities, including work and exercise.

• 12+ weeks: Patients may continue with physical therapy to maintain their range of motion and strength.

Factors affecting HTO recovery time:

• Age: Younger patients tend to recover more quickly than older patients.

• Overall health: Patients who are in good overall health tend to recover more quickly than patients who are not.

• Severity of arthritis: Patients with more severe arthritis may take longer to recover than patients with less severe arthritis.

• Type of surgery: Patients who have an opening wedge osteotomy (OWO) tend to recover more quickly than patients who have a closing wedge osteotomy (CWO).

• Compliance with physical therapy: Patients who follow their physical therapy instructions tend to recover more quickly than patients who do not.

Tips for a faster recovery:

• Follow your doctor's instructions carefully.

• Start physical therapy as soon as possible.

• Ice your knee regularly.

• Elevate your knee when you are sitting or lying down.

• Do not put too much weight on your knee too soon.

• Eat a healthy diet.

• Get enough rest.

  If you have any concerns about your recovery, please talk to your doctor.

The average cost of high tibial osteotomy (HTO) surgery in Delhi, India is between ₹50,000 and ₹150,000. However, the exact cost will vary depending on the type of surgery, the surgeon's experience, and the hospital where the surgery is performed.

Here is a breakdown of the average costs of HTO surgery in Delhi:

• Opening wedge osteotomy (OWO): ₹50,000 to ₹80,000

• Closing wedge osteotomy (CWO): ₹60,000 to ₹100,000

• Hybrid osteotomy: ₹75,000 to ₹125,000

Factors that can affect the cost of HTO surgery:

• Type of surgery: OWO is typically less expensive than CWO, and hybrid osteotomy is the most expensive type of HTO surgery.

• Surgeon's experience: More experienced surgeons may charge more for HTO surgery.

• Hospital: Private hospitals in Delhi typically charge more for HTO surgery than government hospitals.

• Pre-operative tests: The cost of pre-operative tests, such as X-rays, MRIs, and blood tests, can add to the overall cost of HTO surgery.

• Anesthesia: The cost of anesthesia will also vary depending on the type of anesthesia used.

• Hospital stay: The cost of a hospital stay will also vary depending on the type of surgery and the hospital where the surgery is performed.