Martin
Surgical techniques that realign the knee, preserve the joint, and delay replacement.
Knee osteotomy is a highly specialised surgical procedure designed to correct leg alignment and redistribute weight across the knee. It's an innovative, joint-preserving solution particularly suited for younger, active patients with early-stage arthritis who want to maintain their natural joint for as long as possible. Unlike a knee replacement, osteotomy preserves your natural joint, restoring balance and reducing pain: without the need for artificial implants.
By shifting the mechanical axis of the leg, this knee realignment surgery offloads the worn, arthritic section of the knee, allowing the healthier joint surface to bear the weight.
At Orthopaedic Innovation, our treatments are led by a dual-surgical team of: Professor Adrian Wilson and Dr Kristian Kley. Both globally recognised experts in knee osteotomy, our specialists use computer-guided precision and advanced digital planning to determine the precise correction needed for optimal, long-term function.
The History of Osteotomy: A Proven Path to Joint Health
While modern osteotomy techniques utilise cutting-edge digital planning and specialised plates, the concept of surgical bone realignment has a history stretching back to the late 19th century.
The procedure gained significant clinical traction in the 1960s when surgeons began to understand its critical role in treating early-stage arthritis. Today, advancements in imaging, customised instruments, and modern fixation hardware have transformed the procedure, making it far more precise, reliable, and enabling a faster, more effective patient recovery. It remains a critical intervention, especially for patients considered too young or too active for total knee replacement.
The Three Primary Types of Knee Osteotomy for Realignment
The procedure involves surgically reshaping the tibia (shinbone) or the femur (thighbone) to correct the uneven weight distribution. This adjustment shifts the mechanical load away from the area affected by arthritis.
1. High Tibial Osteotomy (HTO)
This is the most common form of knee realignment surgery.
- Location: The correction is made on the upper part of the tibia (shinbone), just below the knee joint.
- Ideal for: Patients with a bow-legged (varus) alignment, where wear and tear is concentrated on the inner (medial) compartment of the knee.
- Goal: To shift the mechanical load from the inner, damaged side to the healthier outer (lateral) side.
- Techniques: The two basic techniques are the Opening Wedge HTO and the Closing Wedge HTO. You can find a detailed overview of this procedure and its application on the Hospital for Special Surgery1 website.
2. Distal Femoral Osteotomy (DFO)
- Location: The correction is made on the lower end of the femur (thighbone), just above the knee.
- Ideal for: Patients with a knock-kneed (valgus) alignment, where stress is concentrated on the outer (lateral) compartment of the knee.
- Goal: To shift the mechanical load from the outer, damaged side to the healthier inner (medial) side. A good summary of DFO indications and techniques is provided by Dr. Thomas Youm2, an orthopaedic surgeon in NYC.
3. Double-Level Osteotomy (DTO)
- Location: A combination of a femoral correction and a tibial correction is performed.
- Ideal for: Patients with more complex or severe deformities where the misalignment originates from both the femur and the tibia.
- Goal: To achieve a complete restoration of the overall mechanical axis of the leg for optimal balance and alignment. Also referred to as Total Knee Osteotomy (TKO) or double osteotomy, this comprehensive approach is necessary to ensure the joint line obliquity is preserved.
For a deeper scientific understanding, you can read Professor Wilson’s paper on Osteotomy Around the Knee: Evolution, Principles and Results3
Choosing Your Correction: HTO vs. DFO vs. DTO
The table below summarises the critical distinctions between the three primary types of knee osteotomy.
|
Feature |
High Tibial Osteotomy (HTO) |
Distal Femoral Osteotomy (DFO) |
Double-Level Osteotomy (DTO) |
|
Bone Corrected |
Tibia (Shinbone) |
Femur (Thighbone) |
Both Tibia and Femur |
|
Alignment Corrected |
Bow-Legged (Varus) |
Knock-Kneed (Valgus) |
Complex Bi-Planar Deformities |
|
Arthritis Addressed |
Medial (Inner) Compartment |
Lateral (Outer) Compartment |
Multi-compartment or Severe Unicompartmental |
|
Typical Goal |
Offload the inner side of the knee. |
Offload the outer side of the knee. |
Restore the entire mechanical axis of the leg. |
Learn more on our Osteotomy webpage
Patient Testimonials: Real-World Results of Osteotomy
Hearing from former patients provides essential human validation, allowing prospective patients to connect with the authentic emotional and functional journey. These stories vividly illustrate the successful return to an active, pain-free life, which clinical data alone can’t fully capture.
Here's how Martin felt almost 24 hours after his osteotomy surgery:
"I got myself changed, went to the toilet, got washed, been back in bed, went downstairs for an x-ray, come back upstairs, had breakfast"
— MartinThis experience demonstrates the effectiveness of modern surgical techniques in ensuring a smoother and safer recovery journey.
Many patients are able to bear weight within 24 hours after the procedure. Furthermore, advanced pain and swelling management, such as Cryo Treatment for Joint Replacements, supports a faster, more comfortable recovery period.
Take the First Step: Speak to Our Team
A knee osteotomy can transform mobility, restore comfort, and extend the life of your natural joint. Our experienced team will assess your condition and help you decide whether a joint-preserving osteotomy or a joint replacement is the best long-term solution for your goals.
To learn more about joint-preserving treatment options and start your journey back to an active life, speak to our patient support team.
1https://www.hss.edu/health-library/conditions-and-treatments/high-tibial-osteotomy-knee-surgery
2https://www.yoummd.com/distal-femoral-osteotomy-hip-arthroscopy-surgeon-new-york.html
3Osteotomy Around the Knee: Evolution, Principles and Results
