High Tibial Osteotomy



  • Well if your recovery is as quick as your typing you will be recovering very quickly! Lets hope it is!
  • thx for the link - yeh, so mine was the Osteochondral Allograft Transplantation - the 2nd process described in your link - parts came from some other poor recently departed chap, and certainly mine was not key-hole as outlined in the 1st procedure - as I have a 3.5" cut over my knee to pair with the 4" cut in my shin for my HTO! I look like a shark attack! ;)
  • Ok so its 5 weeks today post op. I have just taken our dog out for a approx 1 1/2 mile walk. I took it slowly but I managed it with no ill effects. Most of the walk the dog was off the lead which helped alot. Still have a slight limp but it is getting better daily. Had another bike ride yesterday about a 3 mile bike ride with no problems although it was mostly flat. Cycling is a lot easier than walking. One thing I have noticed is you must choose your footwear wisely. I had to get dressed formally at the weekend and like a fool I wore leather ankle boots and was in agony after a little walking. I wore some north face hedgehogs this morning for the dog as it was wet and muddy and still heavier than I would like. I then put on my Nike Pegasus trainers and it was heaven again. I am going to wear my Nikes as much as possible now as the limp is A LOT less with them on.
  • really good to hear you moving around so well at week 5. I was told no weight bearing on crutches, locked in my brace at 0 degrees, and my next appointment isn't until week 6! Tomorrow is week 3 for me - I think at week 4 I might contact my surgeon and see if i am able to make any progress with weight bearing or unlocking the brace.
  • Better to get the recovery right rather than push it. I don't know how much recovery your oats procedure requires. I could be over doing it a d lit myself back. The weeks will soon be gone before you know it. The secretbis doing what you can physically and keeping your mind occupied.
  • yeh, i go back and forth - on one hand I just want this to be over already, but on the other I know proper recovery is months away, and why push things a week or two early and risk further damage?! But, that said, if just going partial weight bearing, so at least I can carry things, will have a huge impact on home life.
  • Went back to work on Monday, what a time to go back! Thankfully phased back working couple hours a day with the view to be working my normal hours in 6 weeks. However occupational health want to see me in 6 weeks to review first. I saw my consultant who was pleased with my progress. Had another leg alignment scan and he said I was exactly where he wants me. Back driving, swimming, but recommends no football or running not even in the future. To be fair I wouldn't be able to run or play football yet. He is a nice chap and he invited me into his office with fellow staff while we looked at the leg alignment results on the computer. He said he doesn't go as far across with the leg alignment as some do to give a longer life expectancy of the joint. I think he mentioned 57 or 59 and said some go as far as 65? I asked about taking the titanium tomofix plate out, and he said if it irritates my hamstring he would take it out. It does indeed make the knee replacement operation easier to perform if it is removed. He wants to see me again in 3 months. Apparently this is because the bone has not fully fused yet, and he wants to make sure the bone heals well. I still walk with a limp and if I overdo it I struggle for a day or two. It seems it is best to try and rest as much as possible then. I am doing squat thrust repetitions and lying down sitting up, lifting one leg straight while pulling toes inward repetitions to build up the thigh and straighten the leg fully. I just need to overcome the last bit of pain I experience in the knee that causes me to limp. This is probably the hardest part because when I do't have pain I overdo it and put myself back again.
  • good to hear you're progressing well. Hopefully the limp will go away soon. I just had my 6 week followup on Monday, and am finally progressing to weight bearing. I'm told I have about another 4-6 weeks of bone healing. Do you know how many degrees adjustment you had made during your HTO? Mine was 5 degrees, which i understand to be at the minimal end of the scale.
  • Hi Matty good to hear from you. Mine was 12 degrees so on the upper end of the scale. Just try and avoid the virus last thing you need!
  • yeah - its crazy out here also. Everyone else is just starting to get cabin fever while i'm coming out the other side after 6 weeks off mostly cooped up inside unable to walk - walked 3.5miles yesterday...of course, I can't go anywhere fun! Lets all hope this thing passes much quicker than anyone thinks....
  • So I found and watched a video, and thought it to be a good insight for others considering HTO. It's a medical lecture (2016) specifically focused on HTO patients returning to sport - this one is focused more on soccer, but the basics being a high impact sport. The general discussion points are that HTO's have improved substantially over the last 20yrs, not just the technique and hardware used, but the understanding of just how far to correct the alignment to get the best possible results. Best results seem to be determined by; age (younger is better), activity level pre-op, the more active the better, the extent of the angle of adjustment - with less of an adjustment required (3-6 degrees) producing optimal chance of return to sport, the reason the HTO is required in the first place - if there is substantial damage to other parts of the knee and factors of that nature, a full return to sport is less likely, and also MOTIVATION of the patient - dedication to physical therapy and determination to follow through and give yourself the best chance. Anyhow, the conclusions seem to be, with optimal conditions, there is a good chance for people to return to sport.

    Anyhow, it's a 30min video, and as it is medical, some of the terms need a google, but, i'm guessing for anyone who is now or at a later date reading this discussion and either considering the surgery or actively recovering from it, it's time well spent: https://www.youtube.com/watch?v=d8krxPis8No
  • I will give it a look thanks Matty. In between looking after the kids. Although slightly bigger issues now happening. World will be a different place after the fallout from the current issues.
  • yeah, we're in home-school nightmare out here also. My folks and extended family are all in the UK, so lets hope we all do much better with this thing than anyone currently thinks..
  • hey, so...do you feel your plate? I was going ok and it wasn't really bothering me. But, my physical therapist....well, one of the exercises to learn to walk again is basically an exaggerated step, where i left my leg very high - almost like a running motion, but obviously done at a slow walking pace. When i lift my leg i REALLY feel my plate. I feel it like a large slug slapped on the side of my leg, and around the knee I feel it really tight, and moderately painful. It's early days, i'm 8 days of weight bearing, so it might be something that subsides, or i get use to. But as my ultimate goal is to be playing sport, i am worried, especially reading through this chain of previous HTO folks, that I will need to get the plate removed. Which is obviously another surgery, and filling the screw holes, and rehab etc. urgh. I hope it doesn't come to that.....
  • Good Morning Matty well it is here! I would say at this stage do not worry about the plate, I also had a lot of pain in that area for a long time. As other people have said on here it is a beast of a recovery. If you are like me and just want to do all you can to get recovered it can be very frustrating, when it seems you are still getting a lot of pain when you think you shouldn't. You can also start to worry. I frequently started to think my operation had gone wrong. The hard truth is it is a slow recovery which I grudgingly have to admit you can't rush. Yes, I had no cast and could walk quite early but I was still in pain and had many setbacks when I tried to push it too much. I would wake up after one bad day of pain and push it again with the exercises when actually I should of just listened to my body and rested. It's about 9/10 weeks post surgery for me now. I had a lot of pain in my knee only recently and wondered why again. I also noticed I was limping more, a lot more at work after only a few minutes. My limping was seemingly getting worse! Then I realised the problem was to do with the way I was walking without realising. A quick google on 'still limping after knee surgery' and I found out that if you walk wrong, your mind starts to mimic limping all the time, which makes sense. I needed to put my heel more into the ground really focus with my head up not downwards (another bad habit I had developed). Quite soon and to my amazement I was walking with very little pain in my knee and much less limp, and it is now a lot better! Who would of thought I had learned to walk with a limp and that was the source of my pain and limp! That may not be relevant to you right now, but it may be later and help others recover quicker too. I feel, and darn well hope this is the end of my major issues! My gut feeling is it is but I have been proven wrong many times. I feel I might be able to run a little as I kind of do it when playing with the kids in the garden but haven't plucked up the courage as I don't want to put myself back again, as I really do feel good now. So good I decided to dig a vegetable patch in my lawn for the kids to grow things. It is about 18ft by 14ft. My neighbour said it would be best to use a spade to dig the turf up and turn it over and then backfill the turf. Which required a hell of a lot of digging! We have had a lot of rain in the last few months which made it slightly easier, so I got stuck in. It took me a good 5 hours in total with regular breaks. My back hurt much more than my knee, and this morning my knee feels great. I know it was probably a stupid thing to do but I am an all or nothing person. Again don't worry too much about the pain at this stage just try to keep positive and be patient. As for the plate don't even worry about that at this stage..
  • You mention it feeling like a slug and moderately painful. That again is quite normal it is a very weird sensation, you are constantly aware it is there. It does pass but takes a long time. There is a hell of a lot of adjusting going on in your knee to quite a lot of titanium drilled in.
  • thanks for encouragement. Things just seem to be going overall so well, but the plate thing has had me worried, esp. reading about others having it removed. But you're right, it's early - and given today is day 9 of weight bearing, it's still very early for me. I basically didn't feel the plate at all until I started going weight bearing, so for the first 6 weeks, so my body is just starting to deal with it. Hopefully, like the knee stiffness, it will just pass as my leg gets stronger and my body gets use to it. I know exactly what you mean about limping tho. I find myself limping much heavier than i need to when i'm not focused on my walking. Actually, when i focus on my walking, i think it's almost perfect, maybe 90%, but i get a mild pain on my knee, probably a 1/10. I think that mild pain puts me into "limp auto pilot" when i'm walking and not focusing on walking correctly. I had hip pain one day on my non-surgery side, and my PT said that was likely due to me overcompensating while limping. Probably 1/3 of my PT over the last 5 days has been balance and walking technique focused.

    On your surgery leg - how does it feel if while standing if you raise your leg up in a bent position - like an exaggeration of walking up a step? That's where i really feel the plate right now, and esp. so at the very top of the plate, immediately below the knee.

    Anyhow, glad you are staying healthy - funny to read you're planting vegetables with your kids - i'm home with my boy we were actually planning on planting some corn to see if we can get that to grow. I bet there's a lot of that going on right now.

    Hope you and your family stay healthy. Where in the UK are you?
  • I totally get the following comment you made, in fact I think this was exactly the problem that bugged me the longest.

    On your surgery leg - how does it feel if while standing if you raise your leg up in a bent position - like an exaggeration of walking up a step? That's where i really feel the plate right now, and esp. so at the very top of the plate, immediately below the knee.

    I had that problem for ages and the pain below the kneecap at the front and yes it was when I raised my leg like you described. I have no pain like that now. I tried to run today, it was more like a stumbling jog! I am sure I could of done better and yes I can kick a football now, although I shouldn't tell you that. I might be able to run in a straight line but twisting and turning, no way not yet, or I am nowhere near brave enough! I live near Diss approx 20 miles from Norwich. What part of the states are you?
  • ok thx - super encouraging to read you having the same symptoms and that that has eased for you. Careful on pushing the running - I know for me, they don't want impact events until around 12 weeks - but perhaps you're close to that time-line anyhow. Can't wait to kick of a football!

    Norwich...never been, I lived nr. Huntingdon for a couple of years...which isn't a million miles away...and my sis lived in Downham Market up until a few months ago. I live in a place called 'Ladera Heights' - which is in Los Angeles, about 15-20 mins north of LAX, about 10 mins from Venice beach, and about 25 mins from downtown LA. It's a nice residential neighborhood, good place for families. If you google map "90056" (my postal code) that'll show you the spot.
  • Yes looks very nice! Not far from the beach at all. Santa Monica close by too.Even Mr Trump has a golf course in the area! Different world out there, never been to the states, my brother has quite a few times. Guess you watch the Galaxy team too? Bet you don't miss home, the climate must be great, just the earthquakes from time to time!
  • yeah, i mean, i've moved around enough to know every place has its ups and downs. LA's big down is the traffic - getting around is a huge pain in the arse. Otherwise LA is a great place to live, on the westside, where i am, the weather is really just nicely warm maybe 48 weeks of the year, spoilt rotten on that front. The US does some things really well, and then gets some things, I think what we would consider in the UK 'easy things', really wrong; guns, healthcare, religion in politics are the biggies. And I won't be spending any time at anything with Trump on it. There's plenty to miss about the UK tho, there's a lot folks don't appreciate until its gone. I don't watch the Galaxy...I'm a boro fan, but I love footy/rugby/cricket/f1. English footy coverage here has gone through the roof in recent years, so that's been good, and we now get good f1 coverage, but rugby and cricket are hard to find, and the 8hr time difference to the UK makes things challenging for live sports. Also the food, they have phenomenal variety and quality in LA, especially mexican and the various asian cuisines, but...the chocolate in the states is utter crap, and English cuisine, which can be plentiful in places like Australia, is very hard to find here - good luck finding a meat pie, pasty, or sausage roll!!! I was raised on that stuff!! I've learned to make most of it now, and I try and get back to the UK every xmas and get my fill! Was actually just 4 days back from my last trip when i fell playing footy and set all this off in motion.
  • Earthquakes are never a bother. 20yrs here and I've never had to straighten a picture hanging on the wall. I guess if we get something absolutely huge, sure. But, everything here is built for quakes, flexible wood frames, homes bolted to foundations, etc. I've probably felt about 6-7 quakes in 20yrs. Mostly it feels like a heavy truck driving by, and as soon as you realize its a quake, it's already finished.
  • Thought I'd drop a line here...I'm from the States and had my HTO in mid January. Had a 15 degree wedge! Also, used a new type of technique where I have no plate. There was a small 'cube' inserted at the widest part of the wedge that was essentially screwed in to the bone above and below. I guess the bone heals in around it. So, it's been two months and honestly I'm doing great. Have had very little pain throughout the whole procedure...knock on wood. First week was hell, but after that, with an attitude change, things have been well. Didn't weight bear for 6 weeks but have been ramping up and am fully walking now. With a limp of course, but that's fading. I was planning on doing my other leg on 5/1 but with all this virus mess, that isn't happening. So all in all, so far so good. I like to hike in the mountains and have lots of trips planned for this Fall, and am hoping that is doable. Prior to surgery, it was so hard to find patient experiences about this technique so I wanted to post something positive. This is a big surgery and one needs to be prepared for that, but it is doable and I'm up moving around after a couple of months and hoping after a couple more I'm doing most activities.
  • thx for posting! Please stick around! I've found reading this thread, even with posts from years ago, hugely beneficial. And having a couple of folks to relate experiences with is very helpful. Interesting to hear of the new technique - i assume you had your 6 week xrays - how was the bone healing around the cube? Do you know what the cube is made out of - synthetic or hardened bone etc? What are your eventual activity level goals when you're finished with all your surgeries?
  • I did have my 6 weeks X-rays and it looked good, but still alot of healing left to go.  15 degrees was the max wedge that could be done I guess.  I have a number of ortho surgeon friends and they all said 6 weeks is really too early to see alot of healing of that wide of a wedge.  Likely to see alot more at 12 weeks and beyond.  I'm in my early 40's and so I'm at the stage of chasing my kids around and want to be able to play basketball with them and just be active.  I love to spend time outside and so lots of hiking and just moving.  Not looking to run any marathons at this point.  I have zero, none, nada of my interior cartilage left so this surgery was a long time coming.  The cube is synthetic but apparently harder than bone.  The system used was out of some place in FL I believe.  I really doubt it was any better or worse then using a plate...both probably have pros and cons.  But I trust my surgeon and that's what he wanted to do.  Bummed I can't knock this other leg out...wanted to get them done.  Likely will push that back to January of next year as I feel I've already been on lock down since surgery and now this virus makes that feel longer.  Could be worse so just taking it in stride.  When did you have your surgery?     
  • cool - yeah, i'm early 40s also, with a 9yr old boy. I had a 5 degree adjustment Feb 4 - so i'm a couple of weeks behind you. I'm fortunate tho in that i'm told the rest of my knee should be in good shape. I had the HTO surgery to protect a part of my lower thigh bone, where I had damaged bone replaced with cadaver bone, as the result of an impact injury almost 30yrs ago, that just got too painful to manage. I'm hoping to get back to regular activity, and play rec. soccer again is my big hope. Yes, i would think with a 15 degree adjustment, not only would you have a larger wedge cut, which will require more bone healing, but that's a bigger change in leg/foot positioning, so i'm sure its a harder adjustment to make to be walking again etc. but sounds like you're making good progress. Where in the states are you?
  • I’m from South Dakota. Spent most of today walking around our acreage and leg feels great. A bit hard bc my right leg is at least an inch or two longer then left leg...which is still very bowl shaped and needs to be fixed next. But to think I’d be here after two months with little pain, having had a 15 degree wedge is great. My surgeon tells me I should feel really good after 3-4 months but the leg will actually be healing for a year. That’s crazy. I see no reason why one cannot return to full activity in time. Just takes patience. 
  • hey, do you guys have swollen knees? I have quite a large swollen knee - but I'm unsure if its as a result of my HTO or my other procedure. Just wondering where you guys are with that. I have good ROM - 135 degrees (my other leg is 138), but it's almost 8 weeks since surgery, and I'm not sure if my knee should still be this swollen.
  • Hmm...I don't have too much swelling. I do notice if I wear a tight sock, it'll leave marks more than on the other leg. So I suppose there is still some swelling. But no swelling in knee. But, it sounds like we had a similar surgery to fix two different problems so our experiences are likely going to be different. I also need to force myself to remember sometimes that this was a BIG surgery and it is going to take awhile for everything to heal...not just the wedge, but the whole structure. I wouldn't worry too much about it, just keep being smart and not over doing it. We are still very early in our recoveries and while it's tempting to want everything to be better by now, that just isn't a reality. Going back and reading some of these comments from others reminds me of that. So, it's progress and patience, over perfection for me at this stage :-) Also, keep icing at day's end, the swelling is likely your body's way of telling you it's healing, but don't overdue it.
  • hey folks. I have my 3 month follow up this Monday, just had xrays done. hoping to get the go ahead to start light impact PT work. How are your recoveries going?
Sign In or Register to comment.