Knee Osteotomy (High Tibial Osteotomy / Distal Femoral Osteotomy) in Bath & Bristol

A knee osteotomy is a knee-preservation operation designed to improve pain and function by correcting leg alignment and changing how weight passes through the knee. It is most often used when arthritis or cartilage damage is mainly affecting one side of the knee, and the joint is being overloaded because of bow-leg (varus) or knock-knee (valgus) alignment. It is also a powerful and necessary treatment in some situations in combination with certain ligament repairs or reconstructions, or complex meniscal procedures (such as a complex repair or transplant).

Mr Simon Abram, Consultant Specialist Knee Surgeon, offers specialist assessment and knee osteotomy treatment in Bath and Bristol. The aim is to reduce pain, improve confidence in the knee, and in many cases delay or avoid knee replacement by protecting the healthier part of the joint.

What is a knee osteotomy?

“Osteotomy” means cutting and reshaping bone. In knee osteotomy surgery, the bone is carefully cut and realigned so the leg is straighter (or deliberately shifted) to move load away from the damaged compartment.

Most knee osteotomies involve one of two areas:

High Tibial Osteotomy (HTO): alignment correction in the upper shin bone (tibia), commonly used for inner (medial) compartment overload with bow-leg alignment
Distal Femoral Osteotomy (DFO): alignment correction in the lower thigh bone (femur), commonly used for outer (lateral) compartment overload with knock-knee alignment

Osteotomy is different from a knee replacement. It aims to preserve your own knee surfaces and ligaments, while improving the mechanics that are driving symptoms.

Why people consider knee osteotomy

Knee osteotomy is usually considered when symptoms are coming mainly from one side of the knee and your alignment is contributing to overload. Common goals include:

Reducing pain from early-to-moderate compartment arthritis or cartilage wear
Improving walking tolerance and confidence, especially on slopes and stairs
Helping you stay active (for example hiking, cycling, gym work, or sport where appropriate)
Delaying the need for partial or total knee replacement
Creating a better “environment” for other procedures (in selected cases), such as cartilage repair or meniscus surgery

Who is suitable (and who may not be)

Osteotomy works best when the knee problem is compartment-focused and the knee still has reasonable movement and stability.

You may be a good candidate if:

Pain is mainly on one side of the knee (often inner or outer)
Imaging suggests arthritis or cartilage damage is predominantly in one compartment
You have a clear alignment pattern (bow-leg or knock-knee) contributing to overload
Knee movement is reasonably preserved and the joint is not severely stiff
You are motivated for rehabilitation and understand recovery is gradual

Other options may be more appropriate if:

Arthritis is advanced across multiple compartments of the knee
The knee is very stiff or significantly unstable in a way that osteotomy alone cannot address
There is widespread inflammatory arthritis affecting the whole joint
Symptoms and imaging suggest a replacement procedure would be more predictable

Suitability is not based on age alone. The decision is individual and based on your knee pattern, your goals, and what will give the most reliable outcome.

Assessment with Mr Simon Abram (Bath & Bristol)

Choosing the right knee-preservation procedure depends on accurately identifying the source of pain and the alignment forces driving symptoms. Mr Simon Abram offers specialist assessment for knee osteotomy in Bristol and Bath, including detailed alignment and compartment evaluation.

Assessment usually includes:

History: pain location, swelling pattern, activity limits, instability, previous injuries and prior treatments
Examination: alignment (bow-leg/knock-knee), range of motion, ligament stability, tenderness and kneecap tracking
Weight-bearing X-rays: to assess arthritis pattern and joint space
Long-leg alignment X-rays (always): to measure how load passes from hip to ankle
MRI scan (usually): to assess cartilage, meniscus and ligaments where this changes the plan
CT assessment of rotation (rarely): In selected cases, especially when the primary issue is in the patellofemoral (kneecap) joint.

The aim is to confirm whether osteotomy is the best option, whether it should be combined with another procedure, or whether a partial or total knee replacement would be more appropriate.

Non-surgical treatment

Many patients benefit from optimising non-surgical care before deciding on surgery. Depending on your knee and lifestyle, this may include:

An offloading brace may be tried as this partly simulates the benefit from an osteotomy
Targeted physiotherapy to improve strength, movement control and load tolerance
Activity modification and low-impact fitness (cycling, swimming, walking plans)
Weight management where appropriate
Simple pain relief and anti-inflammatory medication if suitable for you
Injections for symptom control in selected cases

If symptoms remain limiting and alignment is a key driver, osteotomy may be discussed as a longer-term mechanical solution.

Types of osteotomy and how they work

The operation is planned to shift load away from the worn side of the knee and onto the healthier side.

High Tibial Osteotomy (HTO)

Most often used when the inner (medial) side is worn and the leg is bow-legged (varus)
Aims to reduce medial compartment overload and improve function

Distal Femoral Osteotomy (DFO)

Most often used when the outer (lateral) side is worn and the leg is knock-kneed (valgus)
Aims to reduce lateral compartment overload and rebalance the knee

Combined procedures (in selected cases)

In some patients, osteotomy is performed alongside other knee-preservation procedures, such as meniscus surgery, cartilage procedures, or ligament reconstruction. This is tailored to your diagnosis and goals.

What happens during knee osteotomy surgery?

While techniques vary depending on the plan, osteotomy typically involves:

Making a controlled cut in the tibia (HTO) or femur (DFO)
Correcting alignment to the planned angle
Stabilising the bone with a plate and screws
In some cases, using bone graft or a bone substitute, depending on the osteotomy type

The aim is a stable correction that allows the bone to heal reliably while rehabilitation progresses.

Before the operation

You will usually attend a pre-admission assessment. It is important to inform your team about:

Medical conditions (for example diabetes, heart or lung problems, and any history of blood clots)
All medications, especially blood-thinners that may need adjusting before surgery
Any allergies or previous reactions to medications

Please alert your surgeon if you develop an infection (cough/cold/urinary infection), feel unwell, or have any broken skin, ulcers, or rashes around the leg before the operation.

Anaesthetic options

Your consultant anaesthetist will discuss the safest and most comfortable plan. Many patients have a general anaesthetic, sometimes combined with a spinal anaesthetic or nerve blocks. Local anaesthetic around the surgical area is commonly used to reduce pain during and after the procedure.

After the operation: hospital care and early recovery

After surgery, care focuses on pain control, safe mobility, bone healing, and prevention of complications.

Mobilisation and weight-bearing

Most people use crutches initially. Your weight-bearing level is guided by the stability of the correction and the type of osteotomy performed. Physiotherapists will help you start walking safely and begin exercises early.

Blood clot prevention

Measures to reduce blood clot risk commonly include early mobilisation and medication (and sometimes compression devices), tailored to your individual risk profile.

Length of stay

Hospital stay varies depending on the procedure and your progress with walking, pain control, and confidence on stairs.

Recovery timeline (what to expect)

Osteotomy recovery is gradual because the bone needs time to heal. Most patients notice improvement in stages rather than all at once.

Mr Abram will follow your progress carefully and you will have regular x-rays to confirm the osteotomy is healing well as expected.

Typical recovery pattern (guide only)

First 4-6 weeks: swelling control, walking with crutches, restoring movement
6 weeks to 3 months: progressive strengthening, improving walking distance, building confidence on stairs and slopes
3+ months: return to higher-level activities as strength and bone healing allow

Many patients continue to see improvement for many months after surgery as fitness returns and the knee adapts to the new mechanics.

Benefits and limitations

Potential benefits

Meaningful pain reduction when symptoms are driven by compartment overload
Improved function and confidence in the knee
Preservation of your own knee joint surfaces and ligaments
In many cases, delaying partial or total knee replacement

Important limitations

Recovery takes significant time because the realigned bones must heal
It does not “cure” arthritis, and so milder symptoms may continue despite the improved mechanics and reduced load in the knee
Arthritis may still progress over time, and some people later requiring a partial knee replacement or total knee replacement.

Risks and complications of knee osteotomy

Knee osteotomy is a well-established procedure, but as with any operation there are risks. These include:

Infection
Blood clots (DVT / pulmonary embolus)
Delayed bone healing or non-union (slow or incomplete healing of the osteotomy)
Over-correction or under-correction of alignment
Nerve or blood vessel injury (rare)
Hardware irritation (plate discomfort), sometimes requiring later removal
Progression of arthritis in another compartment over time

When to seek urgent advice after surgery

Increasing redness, heat, wound leakage, fever or feeling unwell
New calf pain or swelling
Chest pain or shortness of breath
A sudden change in leg function, severe pain, or inability to weight-bear

Frequently asked questions

Is osteotomy an alternative to knee replacement?

In the right patient, yes. Osteotomy can be an excellent knee-preservation option when wear is mainly on one side and alignment is driving overload. If arthritis is widespread across the knee, a partial or total knee replacement may be more predictable.

Will I have metalwork in my leg?

Most osteotomies are stabilised with a plate and screws. Some patients notice the plate, particularly if they are slim, and in selected cases it can be removed after the bone has healed.

How long will the correction last?

Longevity varies and depends on factors such as the severity of arthritis, accuracy of correction, activity level, body weight, and whether the rest of the knee remains healthy. Many people achieve long-lasting symptom improvement, but some later progress to knee replacement.

When can I drive and return to work?

This depends on which leg was operated on, comfort, strength, and the type of work you do. Desk-based work may be possible earlier than heavy physical work. You should only drive when you can safely control the vehicle, perform an emergency stop without limitation, and meet insurance requirements.

Can I play sport after osteotomy?

Many people return to low-impact activities such as cycling, swimming and hiking. Higher-impact sport may be possible for some, but it depends on your knee condition, healing, and goals, and should be planned carefully as part of rehabilitation.

Can I be assessed for knee osteotomy in Bath or Bristol?

Yes. Mr Simon Abram offers specialist assessment and treatment planning for knee osteotomy in Bath and Bristol, including comprehensive assessment of alignment and your suitability, physiotherapy and specialist bracing options before surgery, and personalised rehabilitation planning.