Knee · Kneecap & alignment
High tibial osteotomy (HTO)
Bow-Legged (Varus) Alignment with Inner Knee Overload or Arthritis
The condition
When the knee is bow-legged (varus), body weight passes mostly through its inner side. Over time this overloads and wears the cartilage there (medial arthritis) or stresses a meniscus, cartilage, or ligament repair, causing pain along the inner knee with standing and activity.
The surgery
Through an incision below the knee, a precise cut is made in the upper shin bone and a small wedge is opened (or closed) to straighten the leg, held with a plate and screws. The cut is typically planned using custom printed guides and hardware specific to your anatomy, and shifts weight toward the healthier outer side. Meniscus, cartilage, or ligament procedures may be done at the same time. The final plan is determined during surgery.
Recovery at a glance
- Weight-bearing
- You will use crutches after surgery, adding weight in steps: touch-down for 2 weeks, then half weight, advancing to full weight through your leg after the 6-week x-rays; normal walking by ~8 weeks.
- Motion
- No motion limits; bending to 120° by 6 weeks. A brace is used for walking until leg control returns.
- Daily life
- Desk work often within 2 weeks. No driving while taking narcotic pain medication.
- Running
- Only after x-rays show the bone has healed, typically 4–6 months.
- Activity
- Full release typically 6–9 months. Impact sports depend on strength and cartilage health.
A general guide. Your restrictions and timeline may change based on what is found and done at surgery.
Risks & benefits
Benefits: Most patients have less pain and stay active, often delaying knee replacement. Risks are uncommon and include infection, blood clots, the bone healing slowly or not healing, loss of correction, hardware irritation that may require removal, fracture, injury to nearby structures (such as nerves, blood vessels, or cartilage), stiffness, persistent pain, and the need for further surgery. These will be reviewed with you in detail before surgery.
Patient Surgical Information
Open, save or print. Bring your questions to your pre-op visit.
Before & after every surgery