Tibial Osteotomy

Overview
Tibial osteotomy is a surgical procedure used to realign the bones of the knee and improve the way forces are distributed across the joint. It is most commonly performed to treat knee arthritis, malalignment, or instability in younger, active patients looking to preserve their natural knee joint and delay or avoid knee replacement.
By cutting the tibia (shinbone) and changing its angle, this procedure helps shift weight away from damaged areas of the knee and can also correct abnormalities in slope or alignment that contribute to ligament instability or cartilage wear.

Factors Influencing Outcomes
Several factors can affect the success of tibial osteotomy:

• Severity of arthritis or cartilage damage: Patients with isolated cartilage loss in one part of the knee (typically the inside/medial side) often do well.

• Patient age and activity level: Younger, active patients tend to have better outcomes, especially if they follow rehabilitation closely.

• Overall alignment and ligament health: The degree of deformity and associated ligament injuries influence surgical planning.

The Shift Toward Joint Preservation
Tibial osteotomy is part of a modern approach to joint preservation surgery, aimed at realigning the knee to protect the remaining cartilage and extend the life of the natural joint. For younger, active patients with early or moderate arthritis or ligament instability, it provides an excellent alternative to knee replacement.

The Procedure

There are several types of tibial osteotomy, each designed to correct specific alignment problems in the knee. Your surgeon will choose the most appropriate technique based on your individual anatomy and goals.

• Medial Opening Wedge Osteotomy:
  This is the most common type of tibial osteotomy. The surgeon creates a controlled cut on the inside (medial side) of the tibia and carefully opens a wedge to realign the leg. The gap is held open with a specialized plate and often filled with bone graft or substitute to help with healing. This shifts weight away from the worn medial compartment of the knee.

• Lateral Closing Wedge Osteotomy:
  In this approach, a wedge of bone is removed from the outer (lateral) side of the tibia to correct alignment. The remaining bone ends are then brought together and fixed with a plate. This method achieves similar correction but is less commonly used today compared to medial opening wedge techniques.

• Slope-Reducing Anterior Closing Wedge Osteotomy:
  For patients with ligament instability, especially anterior cruciate ligament (ACL) deficiency, reducing the backward slope of the tibia can help reduce stress on the reconstructed ligament. In this technique, a wedge of bone is removed from the front of the tibia, and the remaining bone is closed to flatten the slope and improve knee stability.

• Tibial Tubercle Osteotomy (TTO):
  In this procedure, the tibial tubercle (the bony bump where the patellar tendon attaches) is carefully cut and repositioned to improve kneecap alignment and tracking. TTO is often used to treat patellar instability, cartilage damage behind the kneecap, or in combination with other osteotomies to optimize overall knee mechanics.

Addressing Associated Issues
During tibial osteotomy, your surgeon may also address additional problems inside the knee, including:

• Cartilage restoration: If there is focal cartilage damage, procedures such as microfracture, cartilage transplant, or biologic augmentation may be performed.

• Meniscus treatment: If the meniscus is torn or damaged, it may be repaired or cleaned up during surgery.

• Ligament reconstruction: In cases of instability, ligament repair or reconstruction (such as ACL reconstruction) may be performed at the same time.

Combining these treatments during surgery helps improve overall outcomes and protect the knee joint.

Recovery Process

• Initial Phase (0–6 Weeks): Limited weight-bearing with crutches and a brace while the bone heals. Physical therapy focuses on maintaining motion.

• Intermediate Phase (6–12 Weeks): Gradual increase in weight-bearing, with exercises to restore strength and mobility.

• Advanced Phase (3–6 Months): Continued strengthening, balance, and functional exercises.

• Full Recovery: Most patients return to full activities, including sports, between 6–12 months, depending on the extent of surgery and rehabilitation progress.

Risks and Considerations

• Risk of delayed or incomplete bone healing.

• Infection, bleeding, or nerve irritation (rare).

• Risk of blood clots.

• Persistent pain or stiffness.

• Need for future surgery if arthritis progresses.

• Potential need for plate removal after healing.

Conclusion
Tibial osteotomy is a powerful, joint-preserving surgery that can relieve pain, improve alignment, and delay or avoid the need for knee replacement in younger, active patients. If you are experiencing knee pain or instability, contact our office for a comprehensive evaluation and personalized treatment plan.

Frequently Asked Questions

Will I need crutches after surgery?
Yes. Most patients use crutches and limit weight-bearing for about 6 weeks to allow the bone to heal safely.

When can I return to sports or heavy activity?
Return to sports typically occurs between 6–12 months, depending on healing and rehabilitation progress.

Will the plates and screws stay in permanently?
Not always. Some patients choose to have the hardware removed after the bone has healed, especially if it causes irritation.

Is tibial osteotomy an alternative to knee replacement?
Yes. Tibial osteotomy is often performed in younger, active patients to delay or avoid knee replacement by preserving the natural joint.

Will I need physical therapy after surgery?
Yes. Physical therapy is essential for restoring motion, strength, and function after surgery.