High Tibial Osteotomy

Does anyone have any experience good or bad on the outcomes and post operative recovery for High Tibial Osteotomy?

It's not me but my OH who has been advised that the athritic condition of his knee warrants such a procedure.  Obviously we'd discuss this with the consultant pre-op but would like to get as much info as possible to try to make as informed a decision as possible.  OH had been a runner for many years but had to stop due to bad knee pain 18 months ago.  Our main focus has always been mountain sports - fell running/trail running, fell walking, mountaineering, MTB-ing and he has been unable to participate for the past 18 months as he is limited to short flat walks though he can still cycle.

To me this is a particularly brutal and invasive procedure image - though if all goes well the consultant expects OH would get up to 15 years out of it before needing a full knee replacement.  The trouble is OH has this vision of us out running together on the fells in 6 - 8 months time.  He is reasonably realistic in that he says he would be happy just to be able to do 4 - 6 mile runs and I understand the need to have a positive mental attitude to the operation and to visualise a positive outcome at the end of it but does anyone have any experience of whether his aspirations are realistic or not?

The choices are stark - 1 Do nothing yet and take pain killers.  2 Be fitted for a knee brace and see how it goes (OH is dead set against this) 3. Surgical intervention with an HTO.  He is too young to be offered a full knee replacement and would not be able to run on one anyway.

So if anyone has any good or bad information or any consultants/physio out there I'd really appreciate it.

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Comments

  • I don't know anything about this, but I hope you can resolve it TL. What's the objection to a knee brace? Would it be some sort of permanent attachment then?
  • Knee brace

    This is the type of knee brace he would need Mr P - it's not for running in - though I wouldn't put it past him trying!  He feels that surgery is the best option for him to be as active as he wants to be.  He has worn less obtrusive knee braces but now they do not help anymore.  He thinks that surgery will be necessary anyway even if he went for the brace now - it is just putting off the inevitable.  I'm just a little more conservative in my opinion of how it will be post-op.  It takes up to a year to recover and if you go down the route of breaking a weight bearing bone to reallign your leg - thats pretty traumatic.  I know that bones can knit together stronger than they were before a break - but does that still hold true when you are in your 50's? I don't know....... image.  Ultimately he will do as he feels is right and I will support him 100% either way but I'm not sure what I'd do in his position it's not an easy decision.

  • HMmmmmmm- I'm a surgeon- not an orthopod, though, so can't directly answer the question, but surely if the brace has the chance of delaying the need forsurgery, that's worth a try.

    The HTO will obviously change the alignment of entire lower leg- this is bound to affect running style, and will add to the time taken to get back to running after, I think.

    Re; bone healing- an ective man in his 50's should be OK- different if post- menopausal female, and/ or smoker

    A good additional source of info about post op activity/ return to running might be the physio's that work with this surgeon- I bet they see the patients much more frequently than the surgeon in  the post op period.

  • Thanks for that TC - the brace isn't an option he wants to go down simply because the sort of brace he'd need he couldn't run in anyway. The new leg alignment should actually correct his gait - he is very bandy legged on the left due to the collapse of his knee.

    The thing is that his right leg is also affected by arthritis - not to the same extent as the left currently but I suspect 18 months down the line the right one will need doing too!

    My main concern is that he could go through this and either be worse off or still unable to do the hillwalking and bit of running that he aspires to do.
  • I am two years post op from a tibial osteotomy (I'm 53 years old) . I'm back to running now. My last 5k was 20:30. I'm hoping to qulify for the Boston Marathon this year. My longest run has been 17 miles at an 8:00 min pace.

  • Thats great Rick.  OH had the procedure in May last year.  He has recovered well but is not running.  We are back to long days out on the hill walking, he cycles about 140 miles a week and swims. He is wary of running as the consultant was cautious - this is not a cure it is merely a stopgap before the inevitable knee replacement and what you do with the repair post-op dictates to how long it will be before the replacement. We both realise everyone is different and nothing is set in stone though. OH is still looking to begin running again but probably only ever up to about 6 miles off road.  I think he is just so happy to be pain free (mostly).  Did you have the metal plate removed or have you left it in? 

  • Tigerlily...I had the plate removed after one year. I didn't start to run until it was out.  I highly recommend removing it. The key to running again is to strengthen the quads, calfs, and hams in BOTH legs. This requires a lot of work, but it’s worth it. Also, tell your OH to go to his surgeon before he starts to run and do two things. 1) get a synvisc injection. This will keep the knee lubricated. 2) Have his surgeon take an x-ray of the meniscus on his good compartment. The surgeon can blow up the image and get a good measurement on the thickness of it. Go back in 6 month intervals to get it x-ray'd again and compare it to the previous x-ray. This will determine how quickly the meniscus is wearing out and if you should back off from running. If you want any more info, feel free to contact me at runman888@aol.com.

  • Thanks for your input Rick.  I will certainly pass this on to OH.  image

  • Hi Tigerlily, how's the OH's osteotomy holding up? I'm to have one on the 23rd of this month, currently have mixed feelings. Haven't run for a long time after a meniscus shave a few years back. I can cycle 30 - 40 miles, leg press 200 kg no problem but walking after sitting in the office is becoming painful. i don't mind the old if it's going to improve things and I'm prepared for the long recovery period but my greatest fear is not being able to cycle or get out walking on the hills etc. any feedback would be appreciated.

  • Hi Gonzaleomez, I am 6 weeks post HTO and off to the surgeon on Monday to see if I’m ok to ditch the crutches...  I did Japan Ironman 2 weeks before the procedure so was in pretty good shape, albeit running with a lot of pain… I’m also keen to hear from Tigerlily to see how OH's osteotomy is holding up... but to give you a bit on my experience so far, the first week was quite uncomfortable but I have pushed through with the stretching and exercises and physio all the way till now, I have no pain at all it just feels stiff and restricted, my leg muscles really wasted away so It’s back to the gym for me to get my riding legs back. All in all, I also feared not being able run again, but, I do not regret getting the HTO, and feel very confident I will be back riding/running very soon…

  • Hi Grinder 2, thanks for the update. i'm expecting 8 wks on the crutches. It would be good to hear from Tigerlilly or someone else to hear how things hold up longer term.i think the key to good recovery is having discipline to adhere to the stretching and excersises the physio prescribes in the first few months. have you had any indication as to how long you be off the bike? i'm going to get some entries in for a few sportives for early summer next year which hopefully give me some focus to stick to he recovery plan. I'm not looking forwad to losing leg muscle as I've always had good leg muscle from 20yrs + of front row rugby, but hopefully so dedication in the gym will bring that back. Hope your recovery goes well, please keep me posted as things progress it will be good to have a benchmark know what to expect as the weeks pass. 

  • Gonzaleomez, I went to visit the surgeon on Monday and I am free to come off the crutches (week 6), his plan is that I need to continue with stretching and exercises and can start on a stationary bike in four weeks (week 10) and built to full impact running / riding in 8 weeks (week 14). I’m going to the Physio tonight to start working on the rehab plan… good luck with the Op tomorrow.

  • Hi Grinder 2, It sounds like your recovery is going well. My op has been rescheduled for 13th November. keep me updated on your progress.

  • Hi Grinder2  back home after the op last thursady. Everythings a bit stiff and sore but the op went well. Stumbled twice yesterday and put a bit of weight on the foot , hurt like mad, but all appears Ok. Not looking forward to the next 6 weeks but there's no option so have to man up and get on with it. How are things going for you?

  • Hi Gonzaleomez.  Yes the first 6 weeks were very frustrating for me too; 11 weeks post Op now and all going well... I have been having some issues with muscle and tendon soreness but my physio says it’s normal as the body adjusts to the changes and I will be getting some “tendon over use” pain until my muscles totally recover… I started back on the bike last week (Albeit very slowly) and will continue with some fluid trainer work for a month or so before hitting the road, I still have about 10% less flexibility then my other leg… This is going to take time and I am not going to rush it, just going to continue with the program; Hang in there and make it worth the effort…. Good luck...

  • Hi Grinder 2, got the first 2 weeks out of the way and feeling much better, swellings nearly all gone, flexibility is really good and to be honest i feel like i could ditch the brace now, but obviously can't. had first physio last week, just a few stretching excercises. the only soreness i have is around the back of the and heal most likely muscle and tendon. goning to hit the gym next week to do some light upperbody aerobic exercises to keep things ticking over. i'm under no illusions that there's a long way to go but things are good at the moment.....good luck for when you get back on the road, let me know how that goes.   

  • 24 weeks post op for me , age 48, have completed 230Km bike ride and a few easy 10km jogs, knee improving all the time. Make sure you are down to minimum weight and as fit as you can be before Op, and be patient when recovering .

  • That's good news Dr Wiggins, i'm now 9 weeks post op and pain free with almost 100% flexbility/range of motion. still using crutches for stability, i can get around without them and put 80 - 90% weight on the leg. Just set up the turbo trainer tonight will have a 1o min spin in the morning. the physio reckons about 6 more weeks before i can start to get back on the road bike. biggest issue is going to be losing some weight, i need to drop 2 stone or so which is doable but willtake some time. my consultant reckons i won't run again, i'd like to prove him wrong if only to do the local park run on soft ground. thanks for your update it's always good to hear of peoples positive progress.

      

  • Hi - I'm hoping some peopel who have contributed to this thread may be able to help with some advice.

    I had an arthroscopy to remove some toen meniscus 8 months ago following severe knee pain after a run. Unfortunately this has had no impact and the pain continues to get worse.

    Following a SPECT CT scan my surgeon is recommending an HTO - of course I'm not keen as I have two children and my own business so anything as incapacitating as an HTO is unwelcome.

    I had some basic q's for starters:

    How long are you unable to drive?

    How long should you stay away from public transport?

    How does the leg look after the op? I've heard the change in angle can look quite extreme...

    How quickly could you return to working even if that's at home?

    Prob lots more q's but any help with the above would be hugely appreciated.

    D

  • Hi duswain,

    I had an HTO last November following a menicus shave back in 2009, the damage goes back through 20 years of front row rugby (it was fun at the time!!).

    I was non weight bearing for  10 - 12 weeks and didn't drive for 12 weeks. living in the sticks i rarely use public transport but to be honest wouldn't have felt confident doing on crowded buses/trains anyway whilst i was on crutches or a stick.

    I had a 10 degree wedge/correction and can't really see any noticeable mis-shaping of my leg. i was pleasantly suprised that i didn't loose much muscle mass or strength in my leg during the recovery period, i expected a lot of muscle wastage but it didn't happen.

    i had 3 days in hospital, and started working from home on the pc after a bout a week.      

    I haven't run since the HTO but to be honest hadn't done much running since the meniscus shave after which i stuck to cycling, swimming and gym work. I got back on the stationary bike after 12 - 14 weeks and out on the road after about 18 - 20 from recollection. I can now cycle 30 40 miles comfortably and can squat a similar weight to what i did pre-op. I must stress it is important to build back up slowly and adhere to what your physio tells you.

    The knees not perfect but it's far better than it was pre HTO, i get very little pain and no swelling only occasional tigthness after a long ride or a gym session but this is usually gone by the following morning. the leg does get a bit stiff after siting at my desk for a couple of hours but again this wears off after a quick walk to the coffee machine and back.

    i'll see my consultant at the end of Oct and he will decide whether or not to remove the plate, it's not causing any problems at the moment so he may leave it another 6 months. hopefully he will tell me i can do some light running now as well.

    All in all the HTO has been a great success for me and i would recommend anybody consider it as a viable option. i'm hopeful it will delay a tkr by at least 10 -15 years.

    Theres loads of info on the web so take your time and do some research before making any decisions.           

  • I had a hto Jan 2014. I had problems with the plate and walked with a limp until they took it out nov 2014. I had been off running by than for 20 months. put on 47 lbs. started back with a run walk in January. Have lost 41 of the lbs I put on. Got most of my speed back now. Just ran a 3:05 marathon. I'm 54 now. My knee is always stiff when I get up, but doesn't hurt very often. Was worth all the hassle

  • Hi Gonzalezgomez - thanks for the info, and apologies for delay in replying as I only just saw your message.

    I had some more meniscus removed two weeks ago (posterior horn this time). Maybe it's too early to tell but unfortunately it doesn't seem to have worked and sometimes the knee actually feels worse! However I am now walking without the brace which is good BUT ther definitely seems to be more 'pinching' at the front of the knee.

    Anyhow... I'm assuming my surgeon will now want to move ahead with the HTO so will find out in ate Jan when I go back to see him.

    Was good to read about your positive experience so far and it sunds like you're recovering really well. How did you manage with the non-weight bearing for 10-12 weeks? Am hoping I can be a bit more mobile earlier if possible and also get back to some form of training (even if it's only bodyweight exercises indoors) as soon as possible...

    Thanks again for the info,

     

    Duncan

  • Hi Duncan,

    The 10 - 12 weeks was OK, I could get around on crutches long before that, but lost a bit of confidence after a couple of slips, trips.

    Keep mobile after the op but don't over do it. In the past I've only really paid lip service to what the physios have advised when recovering from minor injuries but this time i followed his instructions to the letter and it has paid off.

    My 12 month consultation was deffered for 6 months so there will be no decision on removing the plate until June 2016.

    I've kept up the gym work but haven't done to much cycling lately, more work on the cross trainer and a couple of sessions in the pool each week (around 40 lengths of front crawl) The swimming's great but does cause a bit a soreness after, i think this is because the knees aren't in a fixed position as they are on a bike, cross trainer or when squatting with weights. That said i plan to stick with the swimming as i plan to do some open water swims next year.  

    Good luck if you go ahead with the HTO, it's relatively early days for me but looks like it was the right course of action.     

  • Hi Dave,

    Good to hear you've lost all the weight and are back running marathons both are pretty major achievements.

    I'm swimming, biking and doing some weights including squats and leg press and all seems well. I haven't tried running because my consultant advised that i wouldn't be able to at the pre op consultation. I'd love to do our local Park Run on Saturday morning but don't know whether to risk it, at least not whilst the plates still in place.

    How was it having the plate out? did you have to stay in hospital over night? were you back on crutches or non weight bearing for any length of time?      

  • Thanks Gonzalezgomez,

    Appreciate the advice - have been the same with recovery advice following this second meniscectomy but mostly because I didn't find the physio advice at all helpful the first time around. And I was strengthening and mobilising myself anyway...

    Will obvs have to be more sensible and cautious next time around.

    Thanks for the advice, it's much appreciated.

    Hope the revovery continues going well.

    Duncan

  • Hi all, 

    I had HTO October 2013, after many year of right knee pain, after breaking my femur, at the growing plate, in 2 places playing rugby at the age of 15 (now 45). This I'm told caused a deformity in my knee(bow leg).

    No more rugby but now football, cycling and hill walking(decending, ouch). By 30ish running was out of the question.I'm a joiner by trade so I'm on my feet much of the day. Knee pain and medication was a big control on my daily life! After 3 arthroscopies, a cartilage OAT graphed , 2 steroid injections and an off loading brace, with little change in pain, I was offered a distal femoral and high tribial ostiotomy, to realign my knee.

    Morning of the surgery the surgeon decided not to do the femur hostility, but put 11degree straightening to my lower leg, 4days in hospital,  4 months off work back to pre surgery fitness, getting a dog help lots of long walks. But the metal plate on the inside of my leg was very uncomfortable. The hospital removed it 1 year after the osteotomy. But for a post surgical infection it's ACE! Ran my first triathlon this year, Olympic distance(challenge not timed) my wife throught I was mad, but I feel I have a long missed life back...image

  • Hi, I realise this an oldish post so hoping for some replies!

    I'm just curious how bad/painful was everyone knees prior to op? 

    I had knee pain off and on for a year, but also a heavy ache in leg, it felt like my good leg had done a 5k but my bad leg had just ran a marathon, so I didn't thiink it was a meniscus tear, however thats what MRI showed. I had the tear removed plus had some small cysts removed. My knee felt 10 times worse after, before I could still run but now I couldn't  without pain or limping. I'm still have the thigh ache problem too. So after physio for muscle wastage ( still not built back up!) Acupuncture, massage, ice baths etc etc not much improvement. A bakers cyst keeps appearing in back of knee causing stiffness and cramps

    My consultant said I had arthritis, I'm starting wish I left my knee alone!

    He also said take painkillers and run, so I did, but can't without limping and some discomfort, not horrendous pain.

    Now ive been offered a HTO as my leg is malalinged ( further xrays) I'm wearing an off loader brace at moment, not comfortable and restrictive but however has reduced pain a lot. I'm now in dilemma whether to have HTO since I'm not in a lot of pain, I describe it as mild toothache type pain that occasionally shoots up if I twist leg wrong way. Is it worth the pain and time for op?I run with a limp but think its partly to my thigh muscles not working properly, not sure if op will help with that. 

    Did anyone have the op even tho they could still be reasonably active? 

    I want to run how I used too, without limp, I want to be able to bend my leg fully too at no I can't kneel down, it just sticks! 

    Cheers 

    Michelle image 

  • Hi Mishmash,

    It sounds like you've got quite a few issues with your knee/leg.

    I had an HTO two years ago, back in next week to have the plate removed. I haven't run since the HTO but to be honest i wasn't a regular/high milage runner before the Op. My main sports were rugby, cycling, gym, swimming and the odd game of badminton. Since the op 've returned to all of them except the badminton, which i feel i could play if i wanted to. I had a meniscus shave a couple of years before the HTO. Pre HTO my knee was gradually deteriorating, i wasn't in constant but would find it difficult to walk for the first 20 - 50 metres or after sitting for long periods and walking for any distance was becoming an issue. For me the HTO has improved things 100% or more. Knee pain is virtually non existent at this time (it will deteriorate over time, but that natural anyway). I get a bit of soreness where the plate is in my tibia, but hopefully this will stop when the plate is removed. Rehab was a bit long winded, 10 weeks or so non-weight bearing (14 weeks off work) i was on the static bike after around 12 weeks things moved on quite quick after that. But I reckon it's taken a good year or more for the knee settle in to new position as it were ie getting used to the loading going through another point.

    i hope to be able to get back to a bit of running after the plate is removed, just the local Park Run on a Saturday morning, but to be honest this is more of a physcological issue than a necessity, i just want to prove i can and have the option to. My consultant advises against it, but says it's my choice. His advice is to stick to current exercise i do cycling, swimming, weights etc and to be honest he's correct, why run when it's proven that the impact is damaging to the joints.

    Although the rehab is a bit long, based my experience i'd recommend the procedure to anyone. i'm pretty much pain free and as active (if not more so) than i was before the HTO. Ultimately i may need a knee replacement but hopefully thats at least 10 years away, in the meantime i intend to look after my knees as much as possible whilst being as active as possible.

    I recommend you to research it on the web as much as possible, you'll find very few negative reports.

      

                       

  • Thanks everyone for the contributions to this post. I'm 42yo and currently in the process of choosing a date for my HTO and am leaning toward early Feb after a holiday. Like Michelle, I'm experiencing only mild symptoms with occasional sharp pain at certain angles so have been doubting whether this is 'bad enough' to warrant surgery. The specialist says the MRI doesn't lie though. I've been into ultra running for the last three years and was training for my third 100km when a month ago my 18 month ache in my knee had become extremely painful and prevented me from running at all. Apart from a stubborn unsuccessful and unintelligent attempt to run 5k, I haven't run since. The specialist has advised that this is probably the end of my running days. I can still cycle now relatively pain free and am just wondering the implications of returning to running after plate is removed etc? I believe it is likely to mean an earlier onset of a knee replacement, is anyone aware of any other implications? Given that knee replacements are fairly common and successful, part of me thinks that returning to running might actually be with the risk?

    Thanks again for the contributions, I've found it difficult to find comments and discussions from similar minded people.

    Steve
  • Hi Everyone,

    I've just seen Steve C3's post and felt it was a good time for me to join the conversation.

    I've only just turned 37 and like Steve I'm booked in for a HTO and a meniscus transplant at the end of February.

    I snapped my ACL and pretty well destroyed the meniscus on the inside of my knee in the late 90s as a 19 YO playing rugby. 1 knee reconstruction and 3 scopes later things were pretty good until 12 months ago when I finished a 10kms race. My knee blew up and took a few months to settle down. I've not run since but have keep up gym work and walking up hills for exercise and snowboarding for fun.

    My surgeon tells me I'm very young for this procedure but given that I've effectively had no meniscus on the inside of my knee for 18 years, things are starting to look pretty ordinary.

    Like Michelle I don't suffer a lot of pain at the present and have agonized over whether the surgery is justified.

    I'd love to hear from:

    Gongalezgomaz - how old were you at the time of your HTO and how did you get on getting the plate out ?;

    Michelle - which way did you end up leaning as far as the HTO is concerned;

    Steve - whether you've learned any more about the implication of running post HTO - I'm likewise interested to know and hope to be able to take it on post recovery if it is not catastrophic to do so;

    Anyone - has anyone had a HTO and had any trouble returning to snow boarding / skiing ?

    Cheers

    Tim.

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