High Tibial Osteotomy (HTO) in Reading — Knee Realignment Surgery
A High Tibial Osteotomy (HTO) is a realignment procedure used to offload damaged areas of the knee and delay or prevent the need for knee replacement. It is most commonly performed for younger, active patients with arthritis on one side of the knee or after ligament injuries that have altered alignment.
Mr Sam Nahas, consultant knee surgeon at Circle Reading Hospital, specialises in precision-planned osteotomy surgery using digital imaging software to optimise alignment and long-term outcomes.
At a glance
- Who it is for
- Younger, active people with arthritis on one side of the knee, good movement and intact ligaments, who want to delay a knee replacement.
- Anaesthetic
- General anaesthetic.
- Hospital stay
- Usually 1 night.
- Walking
- Weight-bear as tolerated from day 1, with crutches for about 4–6 weeks and full weight-bearing by around 6 weeks.
- Driving
- Around 6 weeks, once you can do an emergency stop safely.
- Sport
- About 6–9 months for higher-impact activity; gentle cycling or swimming earlier.
- Patient rating
- 5.0 out of 5 from 31 verified patient reviews on Doctify.
- Waiting time
- New patients are usually seen within a week.
- Cost
- Self-pay consultation £400, with a fixed price for surgery quoted after your consultation. Insured patients need a GP referral.
What is an HTO?
The HTO involves carefully cutting and realigning the upper part of the shin bone (tibia) to shift weight-bearing away from the worn part of the knee onto the healthier side.
A small wedge of bone is either opened (opening wedge osteotomy) or closed (closing wedge osteotomy), and a titanium plate is used to hold the new position while the bone heals.
By redistributing load, HTO can relieve pain, improve function, and help preserve your own joint for many years before a knee replacement becomes necessary.
Who is suitable for HTO?
HTO is most suitable for patients who:
Have arthritis or cartilage damage limited to one side of the knee (usually the inner/medial side)
Have good range of motion and intact ligaments
Are younger or active and wish to delay total knee replacement
Careful preoperative assessment is essential. Not all patients with arthritis are suitable candidates.
The importance of alignment analysis
Before considering surgery, Mr Nahas arranges full-length, weight-bearing X-rays of the entire leg — from hip to ankle — to assess overall limb alignment.
These X-rays must be high-quality, precisely centred, and taken in standing position for accurate assessment.
Mr Nahas then analyses these images using specialised computer software to measure the degree of malalignment and to plan the correction in detail.
This digital planning ensures that surgery is tailored to your exact anatomy, restoring balance through precise angles and millimetre adjustments.
The surgery
HTO is performed under general anaesthetic at Circle Reading Hospital.
A small cut is made on the upper tibia (shin bone), and the bone is carefully opened under X-ray control to achieve the planned correction. A wedge-shaped gap is created and stabilised with a titanium plate and screws.
In some cases, bone graft or bone substitute is added to promote healing.
It is a major operation, and patients must understand that it involves bone healing — meaning recovery takes time and patience.
It is common to feel an ache or a sense of awareness over the plate on the inner shin when you are on your feet a lot, particularly in the first few months. This usually settles as the bone heals and is not a sign that anything is wrong.
The plate is normally left in place permanently. A small number of patients find it irritating over the bone and choose to have it removed once the bone has fully healed — usually no earlier than 12 months after surgery, as a short day-case procedure.
It is a major operation, but for the right patient, it can transform knee function and significantly delay joint replacement.
Recovery and rehabilitation
Because bone healing is required, recovery from HTO takes longer than most keyhole surgeries:
Hospital stay: usually 1 night
Weight-bearing: crutches ~4–6 weeks, but weight-bear as tolerated from day 1 and full by around 6 weeks
Bone healing: checked with X-rays at 6 weeks and ~3 months; functional recovery/union commonly falls in the ~3–4 month window
Driving: around 6 weeks, once you can perform an emergency stop safely and are off strong painkillers; this also depends on which leg was operated on and whether you drive a manual (see Driving after knee surgery)
Return to sport: ~6–9 months for higher-impact activity, earlier for gentle cycling/swimming
Each patient follows a recovery pathway designed for safe healing and return to full activity. The recovery pathway is tailored to each individual's lifestyle and sporting goals. Recovery is criteria-based and not actually based on a fixed time. What this means is you are not allowed to progress to the next phase of rehabilitation if your knee or muscles are not ready. Each patient's timeline will differ depending on progress, and results are not guaranteed as per this timeline. These are approximate estimates.
Evidence and outcomes
High tibial osteotomy (HTO)—a bone-realignment operation that shifts weight off the worn side of the knee—can ease pain and, in the right patient, can delay a knee replacement for many years: in a Finnish national registry of 3,195 osteotomies, 73% of knees had not needed a replacement at 10 years (Niinimäki et al., JBJS Br 2012), and a review of 30 long-term studies concluded that most patients could delay a replacement for more than 15 years (Ollivier et al., KSSTA 2021).
It preserves natural joint movement, maintains high activity levels, and allows continued participation in sports and work that would not be suitable after total knee replacement.
Modern fixation plates and digital planning software have improved accuracy, comfort, and long-term success.
Risks and complications
As with any operation, there are risks. Most patients have no serious problems, but it is important to know about them.
Infection of the wound or around the plate
Blood clots in the leg (DVT) or lungs (pulmonary embolism)
Bleeding, bruising or problems with wound healing
Stiffness of the knee
Numbness around the scar
Risks from the anaesthetic
The bone may heal slowly or not heal (non-union), which may need further surgery
The correction may be lost before the bone has healed
The correction may end up more or less than planned
The plate may cause irritation, and some patients choose to have it removed
A fracture through the hinge of bone on the far side of the cut
Rarely, injury to the nerves or blood vessels behind the knee
A knee replacement may still be needed later
Mr Nahas will go through the risks that apply to you at your consultation.
Why choose Mr Sam Nahas
Consultant knee-only surgeon specialising in realignment and preservation surgery
Uses digital surgical planning to achieve precise correction
Expertise in HTO, DFO, and cartilage preservation
Evidence-based approach, with detailed patient education before surgery
Self-pay and appointments
Self-pay packages available. No GP referral is required for self-pay patients.
Location
Procedures are performed at Circle Reading Hospital, serving patients from Reading, Berkshire, Wokingham, Henley, Oxford, and surrounding areas.