Knee Osteotomy: Realign, Relieve, and Preserve Your Knee

A knee osteotomy realigns the leg to redistribute weight across the knee joint, offloading the area affected by arthritis. This procedure helps to preserve natural joint structures, reduce pain, and delay the need for a total knee replacement.

Patients who are bow-legged (varus alignment) tend to have more wear on the inner (medial) part of the knee, while those who are knock-kneed (valgus alignment) experience stress on the outer (lateral) compartment. A knee osteotomy corrects these misalignments by shifting the load toward the healthier side of the joint.

The Cleveland Clinic¹ explains that by adjusting the weight-bearing axis from the worn side to a healthier section of the knee, osteotomy can restore more balanced movement and function.

A knee osteotomy reshapes the tibia (shinbone) or femur (thighbone) to correct uneven weight distribution. This realignment reduces strain on the worn cartilage, slows arthritis progression, and promotes better long-term knee function.

According to the American Academy of Orthopaedic Surgeons (AAOS)², osteotomy is especially effective for patients under 60 with one-sided (unicompartmental) knee arthritis and good range of motion.

You may benefit from a knee osteotomy if you have:

• Arthritis confined to one side of the knee
• Bow-legged or knock-kneed alignment
• Good knee movement and ligament stability
• Pain that worsens with activity but not at rest
• A desire to avoid or delay a full knee replacement

This treatment is particularly effective for patients who are active, wish to continue sports or demanding physical work, and prefer to retain their natural joint. Read the full overview on our Osteotomy webpage.

The knee osteotomy procedure typically takes around 45 minutes and is performed under general or spinal anaesthetic. Using advanced digital planning software, your surgeon determines the exact angle and degree of correction required to optimise knee alignment and function.

There are several types of osteotomy depending on the location of correction and area of arthritis:

• High Tibial Osteotomy (HTO): The most common form of knee osteotomy, performed on the upper part of the shinbone (tibia). It is usually recommended for patients with medial compartment arthritis or bow-legged alignment (varus deformity).
  
  
  • Opening Wedge HTO – A controlled gap is created on the inner (medial) side of the tibia and held open with a plate and screws.
    
    
  • Closing Wedge HTO – A small wedge of bone is removed from the outer (lateral) side of the tibia, and the bone ends are brought together.
    
    
• Distal Femoral Osteotomy (DFO): Performed on the lower end of the thighbone (femur), this is used for patients with lateral compartment arthritis or knock-knee alignment (valgus deformity). The procedure shifts load toward the healthier medial side of the knee.
  
  
• Double-Level Osteotomy (DTO): A combination of femoral and tibial corrections for patients with more complex deformities. This approach restores the overall mechanical axis of the leg and helps achieve optimal balance and alignment.

• Hospital stay: 1 night
• Day of surgery: Most patients begin bearing weight to reduce stiffness; cryotherapy with Physiolab is used
• Week 1–2: Gentle movement exercises start
• Weeks 3–6: Strength and flexibility exercises progress
• Around 6 weeks: Return to office work
• Following months: Gradual return to high-impact activities

This technique, completed by our dual-surgical team (Professor Adrian Wilson and Dr Kristian Kley) ensures faster, safer recovery, supported by a personalised rehabilitation plan. Full recovery typically takes 3–6 months, depending on bone healing and physiotherapy progress.

Learn about the PhysioLab in our blog: Cryo Treatment for Joint Replacements: A Cool Approach to Faster Recovery

While knee osteotomy is a safe and established procedure, potential risks include infection, stiffness, or delayed bone healing. Over time, arthritis can still progress, and some patients may eventually need a total knee replacement; but osteotomy can delay that step for many years.

Patient testimonials offer invaluable social proof, allowing prospective patients to understand the real-world emotional and functional outcomes of procedures through the authentic experiences of others. 

Here’s what one of our patients had to say 1 day after surgery.