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Last Updated: Oct 23, 2019

Knee Preserving Surgeries (High Tibial Osteotomy, Cartilage Repair) - All About Them!

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Dr. Mukesh LaddhaOrthopedic Doctor • 22 Years Exp.MBBS, Diploma in Orthopaedics, DNB - Orthopedics/Orthopedic Surgery
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Surgery for joint preservation is used to repair damaged articular cartilage because of osteoarthritis and malalignment. High Tibial Osteotomy is a medical or surgical method to realign the knee joint. This surgery especially helps people with knee arthritis to avoid knee replacement surgery, either partial or total, by maintaining injured joint tissues.

People suffering from degenerative arthritis or osteoarthritis encounter a high crushing of the articular cartilage and menisci that can result in their tearing. Unbalanced forces lead to unwarranted pressure on the knee resulting in mal-alignment.  

High Tibial Osteotomy as an Alternative to Knee Replacement:

High Tibial Osteotomy is usually performed on younger people suffering from mal-alignment or arthritis. The plastic and metal parts used in the total knee transplant surgery have a life expectancy of 15-20 years that might result in another knee transplant surgery for a younger patient. That is why high Tibial Osteotomy is referred to the younger patients until knee replacement becomes unavoidable.

Through High Tibial Osteotomy, the knee is re-aligned to take the pressure off the injured side of the knee. One will have to go through some medical tests before the surgery to know the actual condition of the injury. If the mal-alignment of the knee is not treated, it can make difficult for the patients to perform their daily tasks even walking.

Who Are Eligible for High Tibial Osteotomy?

HTO or High Tibial Osteotomy of the knee is more appropriate for young, active people. Patients who do not feel pain under their knee cap and only on a single part of the knee are permitted for knee osteotomy. They should be able to bend and straighten their knees completely. One should consult their doctor before confirming the type of surgery they will be going for as not everyone is suitable for High Tibial Osteotomy depending upon the severity and overall health of the patient.

Types of Osteotomy Surgeries:

  1. Closed Osteotomy Surgery: The most commonly osteotomy procedure used is a closed wedge osteotomy where the wedge bone is replaced through guide wires. The bones are then closed to fill the gap with the removal of the wedge.

  2. Open Osteotomy Surgery: In this type of osteotomy surgery, the bone wedge is opened to add a bone graft to block up the space with the removal of the wedge.


  1. An effective osteotomy postpones the need for knee replacement surgery.

  2. No physical restrictions have been posted for the surgery.


  1. Unpredictable pain post surgery

  2. Longer healing time than partial or total knee replacement surgery

  3. Difficulty in bearing weight on the operated knee

Post-Operative Care:

  1. Physical joint exercises

  2. Protective weight bearing exercises

  3. Use of crutches or walkers as assistive devices

  4. Radiography to correct maintenance of bone  

  5. Pain medications

Take Away:

High Tibial Osteotomy Surgery is performed to avoid Total or Partial Knee Replacement Surgery. This type of surgery is mostly performed on young patients. For most sufferers, this alternative has proven to be working to relieve pain. However, it is always advisable to consult a doctor before opting for this surgery.

In case you have a concern or query you can always consult a specialist & get answers to your questions!

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