High tibial osteotomy is performed when a patient presents with arthritis mainly on one side of the knee, either medially (inside of the knee) or laterally (outside of the knee). The most common is medial osteoarthritis and HTO is performed to shift the load to the lateral compartment.
This is a very effective procedure and is especially beneficial for younger patients who may not be suitable for joint replacements.
In order for HTO to be considered, and primarily the patient must show mal-alignment in the weight-bearing axis. In other words they are abnormally loading one side of the knee joint.
Weight-bearing x-rays are taken to assess whether mal-alignment is an issue and the degree of it. The yellow line on the below image shows weight being loaded through the medial side of the knee.
In order for the procedure to be successful, the lateral (or medial side depending on where loading occurs) must be completely normal or there will be ongoing pain once the load has been shifted.
The “biological knee replacement” can also be performed alongside the osteotomy in order to improve outcomes. This involves using a patient’s own bone marrow cells to produce cartilage.
Bone marrow cells are harvested and implanted onto a biological scaffold that can then be placed over the defect in the knee, as seen in the picture below.