KnotesFree Orthopaedic & FRCS notes, viva stations and higher order SBAs

High tibial osteotomy

High YieldKneethinKbox SBA

Indications

Used for symptomatic unicompartmental medial knee overload in varus knees, especially in younger active patients.

Principles

  • Shift the mechanical axis laterally to offload the medial compartment
  • Usually an opening-wedge or closing-wedge proximal tibial osteotomy

Ideal patient

  • Symptomatic medial compartment disease
  • Varus malalignment
  • Reasonable range of motion
  • Ligaments either intact or addressed appropriately

Contraindications

  • Lateral compartment degeneration
  • Severe patellofemoral disease in some cases
  • Marked flexion contracture
  • Inflammatory arthritis in most settings

Complications

  • Non-union
  • Correction error
  • Hinge fracture
  • Neurovascular injury
  • Change in posterior tibial slope

Diagram

High tibial osteotomy

Written/reviewed by Kishore Puthezhath

Professor of Orthopaedics and Consultant Paediatric Orthopaedic Surgeon

FRCS (Tr & Orth) revision resource

Reviewed: September 2026