High Tibial Osteotomy

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  • Hi all, what a great forum! Thank you so much for everything - so many stories and great encouragements.

    My story - at 14 was hit by a car and knee never healed right. The last 20 years of swimming (collegiate D1 level in US), basketball, distance running, and triathlons - my knee has basically worn down to nothing. My new favorite activity is distance trail running in Switzerland where I now live. But cannot do it anymore. I couldn't do anything but light cycling before the surgery. Even swimming was making me sore and giving me swelling. Now at 35 and with few options, doc said best option is an 8 degree HTO and clean up the knee (remove meniscus tears and bone fragments, some cartilage treatment, etc).

    I am 6 days post op and feeling pretty OK. For all of you who talk about the pain - its horrible isn't it? I don't know if I knew what I was getting into, but reading the stories here makes me think it will be worth it and I can get back to some normalcy... one day. I am HOPING I can run (just jogging, no more marathons) and play basketball again, but will settle for hiking, swimming, and skiing.

    Long road ahead. Thank you for all of your stories. Gonna go do my exercises now and then ice and elevate!
  • best of luck Sam! First few weeks are rough!! I just passed 4.5 months and have the okay now to progress to full-impact - i expect that to take another 6 weeks. I'm currently doing jogging at 90% bodyweight on antigravity machines, and that's going well. Also working with an agility ladder. A good surgeon can do a lot. Everyone's body handles things a bit differently - but, you have a massive influence over the extent of your recovery. Eat right, and do the PT work. It's hard work, and it doesn't come quickly, but stick at it, and you give yourself the best chance at a full recovery.
  • Hi there I am now 5 months post op and thought I would share an update. Well, due to the lock down I haven't seen in person a physio for about 3 months! NHS physio just disappeared completely which I understand. Just a little frustrating as the recovery was going well.I have been having virtual appointments with my employers physio but it isn't the same. I notice Matty you are on anti gravity running machines! Well done. A complete non starter in the UK as no gyms are open at all, as nearly everything has been in lock down including non urgent hospital appointments. So no scan for me.
    Obviously the exercises have been hit and miss due to not being seen in person. I am grateful I had my operation when I did especially when you consider people are not getting cancer treatment in some cases.

    So this is where I am. I am obviously back at work but on modified duties, as my job requires me to be on my feet. I still have a limp which I am irritated about to say the least. Last time I posted I mentioned I had learnt to walk with a limp. While there is an element of that I am not completely sure. I can walk for about 1/2 mile before I start to limp. Sometimes I don't notice but my wife or others comment on it. It really irritates me that I can't seem to to shake this off. The mild pain I get only comes from the plate area, no where else. If I stop and rest for a minute or two the pain seems to go and I can walk a short distance without a limp then it starts again.

    I finally spoke to my surgeon this week and I prepared a lot of questions! Again it was over the phone so not ideal. I explained about my limp and asked if this is normal as I was rather concerned? He then told me it can take a year for everything to knit together fully. I asked him point blank if I was going to have a limp for the rest of my days and he said he hoped not and the goal is to walk normally. He said my last scan was fine and not to worry. He asked me to measure my thighs with a tape to check muscle wastage. I have about 1/2 inch difference which he said was great. He would like me go on a cross trainer, rowing machine as well as my bike to keep building up my muscles.

    I then explained that my occupational health gp, physio and employers are keen to know when I can move on to more duties. He said listen to your body but in the same breath he said you can do what you like you won't damage anything!?
    He then joked I needed to stop limping.

    Joking aside he said the plate can sometimes cause inflammation and affect the hamstring which may account for my limp. He said if I do still have a limp which hasn't improved at a year I could have the Tomofix plate out. He did say I should think about if I am seeing improvement even slow on a month to month basis. Which I think I do to be fair just not as quick as I would like.

    In the past when I did some heavy impact work at home like going up and down a step ladder painting, I would suffer for days after with a heavy limp. Now I don't so much. I didn't tell him I had been laying laminate flooring, all be it with gel pads! I have to say I was dreading that job but actually the next day I have been fine so that is improvement!?

    If I can get rid of the limp I would be so happy and would pronounce the op a complete success so I will have to wait and see. I am seeing a physio in person on Tuesday which I am looking forward too. The weird thing is I can bike for miles and go uphill on my tiptoes with no issues at all and no limping after.. Sorry for a long post.
  • Hey....sorry you're having so much trouble with the limping. I feel very fortunate - although we are on lockdown also here, most medical places are open, just at very limited capacity. My PT office went from comfortably 40-45 patients when i arrived, to 4-6, all masked, screened on arrival, everything sprayed all the time etc - and i was fortunate that my treatment was classed as essential, so i've been able to go. Also, i'm not working right now, so I hit it HARD. I see my physical therapist 3 times a week, and each session is 2.5-3hrs - so typically 8-9hrs per week. I am absolutely exhausted after a session, and have never physically worked this hard. And then I do my own PT at home on top of that. My limp mostly went away around 3.5months post surgery - I do get it, but it is very rare, maybe for a few minutes after an intense PT session. Now obviously, I am getting constant professional assistance, with a whole host of strength building, balancing and resistance exercises, and using antigravity and blood flow restriction equipment. I also walk. More than i ever have - my fitbit tracks me - last month I walked just over 141 miles.

    My advice - I would push hard to try and get yourself more professional treatment to address the limp. My concern would be that the longer you limp, the more normalized it might become, and it might become that much harder to undo. Additionally, if you're limping, other parts of your body are making adjustments, and that can take a toll on other body parts also. Again, I was classified as an essential patient, and I think this is why - it's important you learn to walk correctly. Read that last bit again. We're talking about the way you walk for the rest of your life. Be the squeaky wheel - go get that oil.

    I'm not sure what PT guidance you get there, but while i am using some specialized equipment, there is also a massive amount of work I do that is easily replicated at home with little or no equipment.

    For example, standing on your surgery leg on a firm cushion, and throwing a tennis ball against the wall and catching it is an excellent balance exercise. Then doing the same, but face your body parallel to the wall, and turn, throw, catch, straighten body, and repeat. Do both - front on, and side on - and do it with each leg. As you get stronger, increase the distance from the wall, try the same with a soccer ball etc.

    Leg muscles are obviously key - calfs, quads, glutes, hamstring - target them all individually, and do BOTH legs. Its very important for even walking the both legs receive the same strengthening. If you have some basic exercise equipment - a couple of dumbbells, a tension band - really, there's a huge amount you can do. Seriously I'm 1000% happy to show you a bunch of stuff I do at PT if that's helpful, we can zoom or something, just let me know. But, whatever you do, make it a priority. This is a critical phase of your recovery, and you have to get walking right.
  • Hi Matty, wow you have a lot of support there. I can only dream of that. I have hit a brick wall for a couple of months due to no targeted PT. I would like to take you up on your kind offer of some exercise advice as I am rather frustrated at the moment. I can zoom just let me know what you need. I just spoke to occupational health doctor again and it is getting a bit repetitive. It would be good to try some of your exercises just to see where I am if nothing else and also compare notes.
  • I just hope the issue is because I have not be doing the level of exercise and had PT support like yourself and not another issue.
  • I just sent you a PM with my email address so check that, and we'll coordinate a zoom. I'll take you through the things I've been doing, there's lots of easy stuff that you can do while watching TV etc, which is what I typically do. There's so many factors for recovery from this surgery, i wouldn't get too concerned yet - i would just really make sure you do everything you can on the PT front. When I first went for the surgery, I was chatting to one of my friends who's a doctor was giving me advice. She's had 3 knee surgeries - and she told me, recovery is 90% about the PT. People just don't do it, and as a result, they don't recover right. That's why I've hit mine so hard. You've had this added unusual factor of the pandemic at just the wrong time, but you're still very much within the recovery timeline, so do what you can from home and I'm sure everything will come good. Although anything but a forgone conclusion, i'm now at the point that if the soccer leagues open back up here, I think I would have a good chance of being cleared to play by September.
  • Got your PM, thank you. I was very keen to get on with my PT at the start unfortunately with the Pandemic my targeted PT vanished. I empathise with the physios must be so hard to have to give advice via platforms like zoom.
  • Quick update from my end...I’m just over 5.5 months post surgery. I had a 15 degree wedge adjustment. All is very well here. I’m golfing 2-3 times a week and ride my road bike every day. I also go for long walks. My PT has been non existent for last few months with COVID so I’ve just been being active on my own and moving a lot. My leg motion is so much better after this surgery and I’m scheduled for next leg in December. For anyone thinking about this surgery, knows it’s a BIG deal, but doable with right mindset. So happy I did it, and am very pleased with my progress. As I mentioned in previous post I didn’t have a plate installed but used some other technique whereby they placed a small ‘block’ on widest part of wedge and screwed it in. So just find a surgeon who is vested in your success and don’t look back. Best of luck to all of you!
  • Hey, sorry i'm late to the party. It's good to see so many people on here sharing their advice and similar experiences!

    Matty, i'm in a similar situation to you and i was wondering how you are coping with your recovery now? I'm a 24 year old male who had a HTO done on my right leg Dec 13, 2019 so i am currently 7 months post o.p. I've been playing soccer all my life and had zero knee issues up until i randomly dislocated my kneecap one day during a match in April 2019. After months of rehab and PT, nothing seemed to fix the pain and discomfort that i was experiencing due to damaged cartlidge that the initial injury had caused, so my surgeon suggested a HTO as a means of using the lateral side of my knee to take most of my weight while protecting the damaged side. At the moment, my main concern is that the new alignment still feels so weird and unnatural, and now my left leg is starting to feel out of alignment. Have you started to experience problems on the OTHER leg due to this operation? And are there any particular exercises that you found most helpful during the recovery process?

    Thank you very much and sorry for all the questions!
  • All I can add neos myself pist surgery 7 months is do your glutes. As you read this you will note I didnt see a physio for anout 3 months not good. I did lots of exercise but still hit a brick wall. When I finally got to see my physio about 6 weeks ago she said my thighs, calfs and hamstring were all great but my glutes (what are they I thought) were poor really. I have purchased some resistance bands best purchase I have made. The progress has been a revelation. Try the ice skating exercise.
  • Matty, Everhopeful - thanks so much for sharing.

    I live in Switzerland, as you can see from the name, and am now 3.5 months post op. YES, first few weeks are tough sledding (sledging in UK?). I chose to go completely off pain meds when I came home, and I am VERY glad I did. I think it is good to feel what is going on in your body and know what is pain to stop and when you can push a little further, especially when starting to do PT and flexibility exercises. I also had a super balanced diet, drank bone broth every night for more protein, and did not drink for 6 weeks. Seriously cut out the sugar and eat an anti inflammatory diet - it WORKS. I am already feeling like my old self at 3.5 months. (I would also add I am only 36 so that helps with recovery time).

    Anyone reading this, do the hard work and eat right, it will pay off. Covid has been really good compared to other places so I have been fortunate to still have PT 2x/week and that has been a lifesaver. I am up to biking now for 60 mins plus, long walks, cardio HIT workouts on youtube, and even beginning to jog again for short bursts on grass and gravel. I just jogged my first consecutive mile on grass last week around the edge of a football pitch. It has been over a year since I could run a mile without pain

    Neos - work out your legs and glutes like crazy. I have always been an athlete, triathalons, basketball, you name it I did it. I THOUGHT I had a strong core and glutes until I started physio; I was wrong. When you are bored and watching, tv, do lunges and squats - and watch your knees! dont let the creep inward but keep them aligned from ankle to hip. We have to re-train our legs to rest in a new position with the new alignment and not overcompensate with our off leg.

    For anyone questioning an HTO - find a good doc you like, consider all options, and if you pull the trigger know it will hurt like crazy and require discipline.
  • Hi Sam welcome to the forum! Interesting what you about the glutes. However I will give bone broth a miss! You sound a super fit guy before your operation and it sounds like you are doing very well and ahead of schedule. I wish I had PT all the way through I reckon I would of been at least 2 months further forward. I am doing short sprints on tarmac but it does hurt a little but at least I am improving.
    I went to the beach and I would highly recommend bare foot running on damp sand I felt really good compared to off road or on tarmac. I would love to know if anyone had their plate out at some point and specifically why and how was the op. Not that I have to have it but just in case.
  • Hi All, anyone on here have experience of Hyaluronic acid injections? i'm thinking of having one to hold off right knee HTO for 6 to 12 months, product will be Durolane or Cingal, the latter being a cocktail of Hyaluronic acid and steriod. Had Left knee HTO back in 2014 and thats holding up fine.
  • Hello all, just thought I’d drop a line. I had a 15 degree HTO a year ago. I posted a few times previously about my recovery. Big surgery but recovered and leg feels amazing. Back and hip pain improved dramatically. Three weeks ago I had my other leg done. Same 15 degree correction. I had really bowed legs! Thank goodness I only have two legs as I don’t believe I could do it again. Ha. Gosh, the first week or two is down right rough. Pain, lack of sleep, etc. It just sucks. But at some point, there is a turning point and the pain subsides and the healing begins. For me, I can feel things turning, thank goodness. I’m moving around, off all meds, driving actually, and being more active (on my crutches). I’m not putting weight on it for a few more weeks. But I have started rehab and I think in a month I’ll be hobbling around with any help. So I guess the reason for the post is to let folks know the surgery is doable (twice in a year!), and it’s worth it. Know there will be a period afterwards, maybe a week, maybe a month, that just sucks. It does. Make sure you have help and prepare yourself mentally for a battle. BUT, that doesn’t last forever. The pain goes away and the healing process will start. Best of luck to all. 
  • Hi All, 

    So nice to discover this forum and read all your stories. I’m looking forward to hearing from everyone as our recoveries continue.
    So briefly I had my HTO on right knee March 2020. The Osteotomy was successful in that I now have a satisfactory gap on my knee joint. I had my plate removed 3 weeks ago and was surprised at how painful this procedure was. My surgeon said I was one of the fastest recoveries enabling plate removal early which is good I guess? 
    The road back to the start line is already underway....I’m aware my Marathon days are probably over altho I do have a spot for October’s London Marathon. <div>
    </div><div>Are there ANY successful returns to running post HTO ( 5K / 10K Trail races ) peeps out there? I am feeling like running is most discouraged by our surgeons which is disheartening.

    Best wishes to everyone.

    Matt from SoCal now in UK x </div>
  • Hi nice to hear from you socal. May l ask why you needed to have the plate out as usually it's only if there are complications? At least that is what my consultant told me. I had my op in Jan 2020. So it's been a year. I can run now. I say run because like you say it seems a totally different level to where I was before. I can sprint but nowhere near as fast or as far. Infact I feel sprinting is the hardest part. Jogging is not too bad. Can I run as far? No I can't. Maybe its still early days and TBF I am no sportsman or runner as such but I was fairly fit and played football. Would I play football again competitively? No way I would not be able to do the twists and turns and sprints required. I am however very happy with my operation it has given me a new lease of life and I feel very fit.
  • If I was to choose a sport it would be swimming, cycling or even climbing. I can bike really quickly as good as before. Like you say running is discouraged and I don't want to have a knee replacement in 5 years, whats the point? The way I feel I honestly think my knee will last a long time I have no pain and the balance is excellent.
  • Hi everhopeful1, thanks for your response. In answer to your question my surgeon always removes the plate and screws after 12 months. 90% of the time I understand.
    He says the bone/joints need to bend and flex properly once healed and the plate restricts that movement...4 weeks post surgery and starting to feel less stiff and painful. i am so glad to hear you can run again....it is the impetus for having the HTO in the 1st place.
    So glad you have no pain too.... i'm trying to be patient!
  • Hi socal_brit thanks for the info. It is interesting that the plate restricts movement and flex. I don't know the exact mechanics of how these things do restrict movement I can only state I don't feel l can sprint like l used to and that does seem to be due to restriction of some kind. Cycling is on a par so the plate obviously does not affect those muscles or movement. I would love to hear from others who have had the plate removed and if they were able to have full range of movement particularly with regard to sprint speed.
  • Hi, guys I just had my HTO 6 weeks ago because I had a bow-legged on my left foot. I am in extreme pain in my ankle .burning and very sharp pain and it is still numb in the lower leg. Did anyone experience such pain in that area? It is just a nightmare for me as I can not even sleep at night and the painkillers do not help me at all. The only thing that can help me but only temporarily is the icepack. I am wondering if that pain would ever disappear? it is really becoming hell for me. I hope i can hear from someone here that can help . Thank you
  • Hi Everyone, greetings from Berlin. I had my HTO 2 weeks ago and on the road to recovery. I am 30 years old and had a bad accident few years ago, which was diagnosed wrongly both by the first doctor I saw and MRT scan. I had a ACL reconstruction in 2018 which went very well, but the meniscus could not be repaired. Since the first operation, I always felt my knee was getting better, but under the advise of my current doctor decided to do the HTO - after all he is one of the best in Germany and operates professional athletes. After the HTO, I received no brace and can already bend my legs 90 degrees. Mobility is good, but I have had pain in the calves and ankle - this was bad in the first week, but is getting better now (from reading the forum, I think this is normal). I am allowed 15 kgs on the operated leg and will be upgraded to 40 kg, 3 weeks post op. I am down to just one painkiller a day - mostly every night, where I wake up, pop a pill and go to sleep again. I hope to get rid of this niggling pain in the coming weeks and dump my crutches in the garbage :) Any tips on how to reduce the niggling calve and ankle pain, besides leg pumps and icing, are welcome.
    Thanks to everyone for sharing their experience!
    Best,
    Sidney
  • Hi everyone, this has been a really useful and helpful thread. Im scheduled to get an HTO next week. Feeling a bit anxious and looking for some other runners experiences and advice.
    Thanks to everyone for sharing their experiences so far
  • I just had a high tibial osteotomy a week ago. Wanted to get some advice. The stinging burning pain is horrendous when standing so all I can do is lie on the sofa with my leg elevated. I can’t do anything. I’m shocked. Help!!
  • Hi Tahir. Sorry to hear you are in such pain. I remember those first few weeks are horrendous. You need to hang in there. It WILL get better. You also need to be patient and follow the advice you get from physio. I am now over 3 years post op! Had mine just before covid broke out. I had about 10 months before l felt really confident the operation was a success. Even then after a year l still wasn't running like l wanted to. The full recovery is LONG. At least in my case. Now l feel fantastic! Running at sprint is brilliant and I get no pain at all from the knee. I am still careful of course. No football or trampoline as I don't want to risk any potential damage. Yes it isn't as good as a knee without a plate but it really is very close. In fact l am going to the mountains in May to do two 5 hour ridge scrambles. Something l thought l would never be able to do. I would love to hear how others on this forum are getting on now. Especially long term like 5.10, 15 or even 20 years post op.
  • Thanks a lot for the response. I really appreciate it. This week is a lot better than last week. First few days out of the house. Hobbling on two crutches to the end of the road and back. I feel like there is a long road ahead. Your comments provide inspiration that there is a light at the Enid the tunnel. Best Tahir
  • Hi Tahir. I was exactly where you were. The pain on crutches the first few weeks was almost unbearable. Needed my leg elevated all the time. But it does get better. Once that initial burning pain is gone, it get so much easier. I'm now 6 years since my op. I don't limp, no constant pain. The odd night I'll get pain when there's a quick drop in temperature, but that's due to my arthritis. My only goal was to be pain free and able to walk. This was achieved so much quicker than in anticipated. Glad to hear you're now getting about easier. You'll get there. My quality of life is incredible now. Wish you well.
  • Hi moonheid

    Thanks for those kind and inspiration words. I am now three weeks post surgery and that burning pain has now mostly disappeared. I want to eventually run and hike. It will be interesting to see how long that takes. My leg muscles have halved in size and I can’t contract the quadriceps. Does anyone have any thoughts. ?!
  • Hi

    It’s now 6 months since my surgery. I’m
    In a much better place. I can run now but really poorly. Still so much better. I still get the pains from the arthritis but less so. I walk with an unusual gait but that is to be expected. However I am really happy with the outcome
  • Hello Tahir, nice to hear that
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