High Tibial Osteotomy (HTO) Rehabilitation

Overview Sections 1 and 3 ~90°Knee flexion target by 2 weeks 6 wksLoad-progression pivot in nearly every protocol 3 moFormal return-to-activity phase begins 6+ moFull, pain-free return to unrestricted activity What an HTO is A high tibial osteotomy cuts and realigns the upper tibia to shift the weight-bearing line from a worn or overloaded medial compartment towards the healthier lateral side, in a knee with varus alignment. The aim is to relieve medial knee pain and slow arthritis progression while keeping the patient's own joint, often delaying or avoiding a knee replacement. Rehab runs longer than after uni-compartmental or total knee arthroplasty, because it has to wait for bone healing at the osteotomy. The typical candidate Alignment Varus malalignment, usually under 15°, with the deformity in the tibia Symptoms Pain isolated to the medial joint line Knee status Near-normal lateral and patellofemoral compartments; good ROM (flexion under 90° or a flexion contracture over 15° predict poorer outcomes) Patient Active and relatively young; non-smoker; BMI under about 30 Factors that change the timeline Whatever the type, these push loading and progression later. Check the op note and the first post-op visit. Factor Effect on rehab Lateral hinge fracture Less stable construct; slower weight bearing, more X-ray checks. Linked to nonunion and collapse. Large correction Bigger gap to heal; early full weight bearing is proven safe only for small corrections Non-locking or spacer plate Protected weight bearing for longer (8 wks to 3 mo) Smoking Slower bone healing; excluded from the early-weight-bearing evidence Poor bone quality, high BMI More cautious loading at the surgeon's discretion Pain, swelling or warmth over the osteotomy Use as a live guide: if it increases with a progression, drop back a step