Bilateral HTO

Bilateral HTO corrects the alignment of both knees and prevents further damage to the joints. The surgery can be a particularly good choice if you enjoy an active lifestyle as it can enable you to continue playing sports without further damaging your knees. It should also help to relieve symptoms such as pain and stiffness without the need for a knee replacement

When is it Performed?

High tibial osteotomy or HTO is a procedure which realigns the leg to redistribute the weight across the knee most commonly to spare the inner part of the joint. It can be used to treat symptoms such as pain and stiffness affecting the knee. The realignment protects the damaged parts of the knees. Osteotomy is most commonly used to treat osteoarthritis but it may be considered if there are other kinds of damage such as ligament injury. A bilateral HTO may be offered if both knees are affected and doing both sides at one sitting reduces the overall recovery time. Osteotomy may be the best choice if you are more active and in Mr Dawson’s practice it is not uncommon to undergo this surgery even if you are over 65 years of age (see testimonials). Outside of Japan Mr Dawson has the largest experience of bilateral osteotomy surgery anywhere in the world.

The Procedure

Bilateral HTO surgery involves realignment of the bones in both knees during the same operation. Cuts are performed at the top of the shin bones and bone grafts of a specific size are measured to fit a precise gap created by opening a wedge shape. The new alignment is then fixed robustly with titanium surgical plates. The procedure will be carefully planned in order to ensure that weight is distributed correctly across the knee joint. It should help to relieve the pressure on the inner knees and to correct the alignment of the joint.

You will usually need to spend a two nights in hospital following a bilateral HTO. The experience gained from managing many such patients informs the optimal rehabilitation. A wheelchair is required for 4 weeks and the use of a ‘Banana Board’ - a yellow plastic device to help transfer from one surface to another - will aid your recovery. Whilst you will not be able to put full weight through your legs for the first 4 weeks, the use of crutches in a specific style will allow transfer and short distance ambulation. Typically you will use crutches up till about 8 weeks post surgery and will be off manual types of work for between 3 and 4 months. Physiotherapy is an important part of your recovery and should be scheduled prior to your operation. The physiotherapy protocols for osteotomy are included in the physiotherapy section on the website. Most patients will be able to return to all of their usual activities, including playing sports, after they have recovered from the procedure. Whilst the recovery from total or partial knee replacement results in quicker pain relief by a few weeks, the overall benefits of osteotomy far outweigh this short lived benefit in terms of levels of activity, flexibility and preservation of the knee joint in the medium to longer term.

Risks and Benefits

• Surgery always carries a small risk of complications such as infection, blood clots and adverse reactions to the anaesthetic. The doctor will ensure that you understand these before the operation.
• The procedure should help to relieve pain and stiffness in the knee.
• Having the operation should reduce the pressure on the knee joint, which should reduce the risk of further damage to the bones and cartilage.
• Correcting both knees can help to improve your gait and reduce the appearance of bow-leggedness.

If you are interested in the bilateral HTO procedure, make an appointment for a consultation with Mr Matt Dawson at the Cumbrian Knee Clinic to learn more.

Bilateral HTO Physio Protocol

Download Bilateral HTO Physio Protocol

Additional Information

Personal tips and experience form a patient who underwent a Bilateral HTO