High Tibial Osteotomy (HTO) – Joint Preservation Surgery


Feature Summary

Young, active patients with early osteoarthritic change over knee joints can benefit from high tibial osteotomy surgery, including a significant pain relief and to delay or eliminate the need of total knee replacement surgery.



In young, active patients with early osteoarthritic change over knee joints, total knee arthroplasty may not be the best choice of treatment because of increased risk of implant failures because of extremely high level of functional demand. Therefore, high tibial osteotomy plays an important role in such a population.

Varus alignment is often seen in patients with an osteoarthritic knee joint, which might be related to medial side cartilage wear, increased tibial or femoral varus alignment. This varus alignment would lead to increased load and cartilage wear on the medial side and thus make the alignment more varus, which is a vicious cycle.

The aim of high tibial osteotomy is to make the alignment more valgus and shift the load toward lateral side of knee joint. This surgery can effectively relieve pain symptoms and to slow down the progression of osteoarthritis.


Procedure Summary

The surgery takes approximately 50 minutes with three major steps.

Wound size is about less than 10 cm, on the medial side of the leg.

Step 1. Tibial osteotomy

Step 2. Correction toward the designated angle (more valgus)

Step 3. Fixation with plate

After surgery, no splint or cast is required. There is no limitations on range of motion exercises or any position of the operated knee joints. Patients is allowed partial weight-bearing with crutches for 6 weeks. Weight-bearing without restriction is allowed after 6 weeks.


  • Pre-operative planning

        Long film x-rays and CT scan of lower extremity can provide accurate and useful information about the cause of varus alignment.

  • Bone bank

        We have one of the largest and best bone bank in Taiwan, which provided structured bone graft to augment the site of correction. This can eliminate the need to harvest autograft from patients’ pelvic bones, which is often pretty painful.

  • Custom-made 3D cutting jig

        Custom-made 3D cutting jig based on pre-operative CT scan can optimize the accuracy of correction and effective shorten the procedure time.

In addition, for patients with valgus alignment with lateral side cartilage wear, we can perform distal femur osteotomy (DFO) in a pretty similar and simple fashion.


Estimated cost

The procedure cost is around 300,000 NTD, depends on the actual medical expenses.