High tibial osteotomy (HTO) can be aptly described as a technique aimed at realigning the knee. A part of your shinbone just below the knee is chosen as an osteotomy region. The end of the shinbone on the opposite side to this region can either be opened or closed before plating it for fixation. The main purpose behind a high tibial osteotomy (HTO), typically in the situation of osteoarthritis, is to unload the damaged arthritic compartment of the knee, generally the medial compartment, reducing the pain experienced by you. The traditional method of correction is guided by the method of Farkas and a modified method of Coventry. The conventional osteotomy technique (the open wedge HTO) is indicated in younger patients coupled with either genu varum significantly or a tibial femoral angle (TFA) of 175 or more, tibia that is more vertical to the ground, and a body mass index (BMI) of 26 to 30. In contrast, the indication for the fibular head closing wedge high tibial osteotomy mostly comprises people older than 50 years who are in the position of an arthritic 4-6 degrees varus of the loading axis associated with severe or end-stage osteoarthritis or generalized arthritis.
What to expect after HTO is slightly different in each hospital, especially due to different materials used for osteotomy. Still, the recovery process itself is geared to the phase of bone healing and the possibility of loading the operated limb. Recovery of patients after surgery is one of the factors that contribute to their overall satisfaction with the treatment. During the immediate postoperative phase, treatment may seem to be lacking; because of this, it cannot be assessed in the marketing offer as being the main reason affecting the decision in the choice of a hospital. However, each patient will certainly pay particular attention to the issues of “what awaits me in the process of physical healing after such a large procedure” and “what period of time it concerns”. It is mentioned that complete high tibial osteotomy recovery takes about 6 months; however, a comprehensive plan for return to full fitness should be considered after 9-12 months. The bone-deep recovery period after an open osteotomy is up to 6-8 weeks, depending on the test confirming the completely closed gap of the non-weight-bearing three parts of the legs, ensuring complete rest for the knee joint. In comparison, full HTO recovery time after internal fixation with a locked plate is procedurally triggered by shortening the upper limb of the cot and transferring the load to it. It is important that patients are prepared for emotional healing when their mobility will be inadequate, and kneading, as the image prior to the surgical operation, will be the outcome of hand or will be significantly re-adapted.
High tibial osteotomy recovery (HTO recovery time) is unique and can vary from person to person. Many factors can influence recovery times. Factors that can influence recovery times include patient age, overall health, the presence of other conditions or diseases, and pre-existing deformities or deficits before a person undergoes HTO. The type of osteotomy and the surgical technique used are also extremely influential. A cut below the genicular vessels can result in almost twice as long a recovery time compared to a lateral closing wedge osteotomy, nearly 18.5 months compared to 9.8 months. Surgical techniques that promote a faster high tibial osteotomy recovery time focus on decreasing the amount of soft tissue damage at the time of surgery and minimally invading or disrupting the knee joint. Post-surgically, it is extremely important for the patient to participate in rehabilitation and adhere to all recommendations and protocols given to them by their healthcare team. Failing to do this can slow recovery time.
The ability to participate in rehabilitation and the time it might take to fully HTO recovery time can be quite uncertain, and each patient’s circumstances and injury are unique and individualized. Healthcare providers will look at many factors including the patient’s age, sex, severity of disease, medical condition, and their choices, and then adjust the plan of post – high tibial osteotomy care and rehab to those needs. Many factors, inside and outside of the patient’s body and the care of possible surgeons, play a part in the overall outcome of medical procedures. If these potential factors can be pinpointed and their influence clarified, patients and healthcare providers may have a much better understanding of the possible outcomes following their decision to have surgery. Physical and psychological factors may be involved in post-surgery outcomes and HTO recovery time. If a person is more motivated to get well or has a strong support system around them, it may help them stick to the rehab program.
The most common problem patients note what to expect after HTO surgery is severe pain, and it is not possible to fully relieve it. Some patients require additional anti-inflammatory medications to reduce swelling and pain. Furthermore, walking with crutches is often difficult. When the leg is still swollen, patients can often walk while leaning on one side so as not to fully transfer their body weight to the operated leg. It is necessary to train walking by fully using the operated leg to avoid gait disturbances. Furthermore, some patients may feel uncertain when transferring weight. This instability is a natural occurrence of what to expect after HTO surgery, but patients must exercise to maintain range of motion in the knee and help the muscles stabilize the knee. Severe swelling can occur. Swelling improves in the long run, but it may be present during the first year after surgery as well. Hemarthrosis can also occur. The aim of the rehabilitation after this surgery is to help the muscles to fully function, so patients wear a non-weight-bearing brace to avoid overload or injury to the damaged part of the tibia.
The vast majority of patients manage to recover well with this surgery. Some complications can occur after this surgery, including problems related to anesthetics, but deep vein thrombosis and blood clots can form after the surgery, as well as thromboembolism, thrombosis, and an embolism in the lung vein. Furthermore, local complications include loss of feeling in the area due to nerve damage, infection, and fever due to loosening of the clips that help in healing, as well as suppression of platelets due to insufficient bone healing. Unscheduled disruption of the administered metal, residual pain, and swelling can also occur, as well as general malaise due to problems with leg alignment.
There is evidence showing long-term improvement in various patient-focused outcomes during HTO recovery time. A high percentage of patients receiving HTO describe good joint function, are free of severe pain, and feel satisfaction with the surgical outcome for up to 15–20 years. However, only a part of the studies assessing long-term survival and clinical outcomes after HTO are prospective. Consequently, some studies do not consider factors such as patient adherence to post-operative rehabilitation exercises and decisions made by patients about the lifestyle they choose post-surgery. Some complications and incorrect patient-treatment matches could be associated with the nature of the patient and the pre-operative condition.
Greater improvements in clinical and radiological outcomes are expected in patients with a stable post-operative limb alignment and maintenance of this alignment at the 12-month post-surgical follow-up. Finally, as post – high tibial osteotomy care, the patient should attend periodic follow-up. During these visits, a clinical examination should be performed, and patient-focused outcomes should be compared with the pre-surgical condition. This assessment can inform if an unadjusted approach is followed by the patient, and if a new surgical intervention should be considered to provide the patient with other good intra-operative options.
Recovery after high tibial osteotomy explained: It is an often slow and sometimes frustrating process. Many patients are non or limited weight-bearing for six weeks, followed by a slow progression toward putting their full weight on their operated leg. The early part of rehabilitation is focused on pain control, swelling management, limits in positioning the leg, and protection of the repair, which is more likely identified as a nonunion. Between six and twelve weeks, most patients are evaluated and given the “green light” to begin progressing their rehabilitation and activity under the care of physical therapy. Many orthopedic surgeons utilize a rehabilitation protocol that is specific for their patient population. With more orthopedic surgeons performing reconstructive procedures, the use of rehabilitation protocols is becoming more standardized. There are no randomized controlled studies to date on different rehabilitation programs and what is the optimal rehabilitation following osteotomy.
Patients who have high tibial osteotomies receive their rehabilitation programs from their surgeon. It is believed that with the various surgical techniques for high tibial osteotomy, the rehabilitation program should be individualized. Resorting to such programs as home-based protocols without the use of physical therapy may enhance a patient’s successful recovery with a high rate of union. Pain can be a complicating issue in the recovery process. It can be managed by prescription medication or over-the-counter pain relief. There are also many programs utilizing physical therapy for guided range of motion exercises and strengthening that have had successes as well. It is important to not forget patients who have undergone the closed wedge or dome; although these patients are weight-bearing, they usually have significant bone pain for months as the bones unite. It is essential for surgeons and patients to have goals and milestones set in the recovery process. There are complications that can occur during this time period that could alter rehabilitation. Significantly fewer complications have been reported following the opening wedge compared with the traditional closing procedures. Any swelling or effusions in the joint usually decreases. Physiotherapy and strength building have had successes as well. It is therefore critical at 12 weeks to begin to establish rehabilitation goals that need to be met for a return to normal activities. During this crucial phase, deformity correction is important.
Our goal is to improve the quality of life of patients by managing the process of limb lengthening and boot lengthening in a healthy and safe manner.
Our doctors are ready to make a treatment plan tailored to your needs within 24 hours.
