What is GetgoodKnees?

An orthopaedic surgery portal merging clinical expertise with evidence-based surgical research for patients and medical professionals.

All Procedures

Knee Osteotomy

Success: 85–90%

3–4 months for bone healing; 6 months for full activity.

Realignment surgery correcting varus or valgus deformity to redistribute load away from the damaged compartment, delaying the need for joint replacement.

Overview

High tibial osteotomy (HTO) or distal femoral osteotomy (DFO) are joint-preserving procedures that correct mechanical axis malalignment. By realigning the limb, load is transferred from the worn compartment to healthy cartilage. The procedure involves a controlled bone cut with gradual opening or closing of the osteotomy site, fixed with a plate and screws. Modern planning uses long-leg weight-bearing radiographs and sometimes 3D-printed patient-specific guides for precision. Osteotomy is particularly valuable in young, active patients with unicompartmental arthritis who are not ideal candidates for joint replacement.

Indications

Unicompartmental osteoarthritis in young patients
Malalignment causing asymmetric joint wear
Medial compartment overload with varus deformity
Lateral compartment overload with valgus deformity

Recovery

3–4 months for bone healing; 6 months for full activity.

Patient Information Video

Mr Getgood works with an Australian company called Personalised Surgery that has produced the following patient information video on knee osteotomy.

Types of Osteotomy

The specific osteotomy technique is selected based on the location and magnitude of deformity, the compartment affected, and any associated pathology. Mr Getgood will determine the most appropriate procedure at consultation using your full-length standing X-rays, 3D CT scan and clinical assessment.

Rehabilitation Programme

The goal of realignment osteotomy surgery is to reduce the load placed through a specific part of the knee, thereby reducing pain and protecting the ligaments or articular cartilage. It is common for other procedures to be performed simultaneously — such as ACL reconstruction, meniscus transplant, or cartilage repair — and rehabilitation will be tailored accordingly.

A similar programme is followed for both femoral (DFO) and tibial (HTO) osteotomies, whether opening or closing wedge, when using internal locking plate fixators.

Phase / Time	Brace & Weight Bearing	ROM	Exercises & Modalities
Phase I Weeks 0–2 Immediate Post-op	Tracker brace locked only when ambulating; full ROM allowed during exercises; worn 24 hours per day (can be removed during therapy). Flat foot feather touch weight bearing with crutches.	Full range of motion.	Patellar mobilisations Heel slides (± slider board), calf & hamstring stretches Quad/ham co-contraction, gluteal activation (supine or standing), isometric hip adduction/abduction, ankle pumping Sitting passive leg extension with roll under heel if extension lag Non-weight bearing hip stability: abduction, extension, external rotation, clam shells, supine bridging on Swiss ball Ankle theraband plantar flexion, sitting calf raises Modalities: Ice compression therapy and IFC as needed to reduce pain and swelling. Compex/muscle stimulation to assist quadriceps activation. Blood flow restriction (BFR) therapy during strengthening exercises.
Phase II Weeks 2–6 Progressive WB & Strengthening	Advance to weight bearing as tolerated with crutches; continue tracker brace until adequate quad control. Ensure normal heel–toe gait. Can remove brace when sleeping.	Progress to full ROM as tolerated (flexion and extension).	Patellar mobilisations Sitting passive leg extension with roll under heel Supine with legs up wall — heel slides (knee flexion) gravity-assisted Bike pendulums: high seat ½ circles forward/backward → full circles — lower seat as tolerated Progress 2 crutches → single crutch → full WB, maintaining normal walking pattern Mini wall squat (30°) → progress to 60–90° (± wall) Shuttle (one bungee cord): 2-leg squat (¼–½ range) and 2-leg calf raises → progress slowly to 1-leg, increasing ROM & resistance Sit to stand 2 legs with high seat height (± muscle stimulation) Supine on floor, legs on Swiss ball: bridging → bridging + knee flexion (heels to buttocks) Wobble boards with support through full ROM: side-to-side, forward/backward Modalities: Ice compression therapy and analgesics as needed to reduce pain and swelling. Compex/muscle stimulation to assist muscle activation. Blood flow restriction (BFR) therapy during strengthening exercises.
Phase III Weeks 6–12 Advanced Strengthening	No brace. Full weight bearing. Ensure normal heel–toe gait.	Full and pain-free knee range of motion.	Sit to stand 2 legs → progress by decreasing seat height Bungee cord walking: forward / backward / side step with slow controlled return Static lunge (¼–½ range) → dynamic lunge step (¼–½ range) with proper alignment (shoulders over knees over toes) Step ups and down 2–4" height: lateral and forward Wobble boards side-to-side, forward/backward: without support, without vision Single leg stance 30–60 seconds (when full WB) → progress to unstable surface with and without vision Cardiovascular fitness conditioning Modalities: Ice compression therapy and analgesics as needed to reduce pain and swelling. Compex/muscle stimulation to assist muscle activation. Blood flow restriction (BFR) therapy during strengthening exercises.
Phase IV 3–6+ Months Return to Activity / Light Sport	As tolerated per surgeon guidance.	Full and pain-free.	Progress resistance on shuttle: strength & endurance, 2 → 1 leg Static lunge (full range) → dynamic lunge → lunge walking Forward and lateral step-ups 4–6–8" (watch for hip hiking or excessive ankle dorsiflexion) Eccentric lateral step-down on 2–4–6" step with control Shuttle standing kick-backs (hip/knee extension) Single leg stance on unstable surfaces (pillow, mini-tramp, BOSU, Airex, Dynadisc) with/without support → progress to no vision Cardiovascular fitness conditioning Sport-specific training as indicated Modalities: Blood flow restriction (BFR) therapy during strengthening exercises.

Phase I — Weeks 0–2

Immediate Post-op

Brace & Weight Bearing

Tracker brace locked only when ambulating; full ROM allowed during exercises; worn 24 hours per day (can be removed during therapy). Flat foot feather touch weight bearing with crutches.

ROM

Full range of motion.

Exercises

Patellar mobilisations
Heel slides (± slider board), calf & hamstring stretches
Quad/ham co-contraction, gluteal activation (supine or standing), isometric hip adduction/abduction, ankle pumping
Sitting passive leg extension with roll under heel if extension lag
Non-weight bearing hip stability: abduction, extension, external rotation, clam shells, supine bridging on Swiss ball
Ankle theraband plantar flexion, sitting calf raises

Modalities: Ice compression therapy and IFC as needed to reduce pain and swelling. Compex/muscle stimulation to assist quadriceps activation. Blood flow restriction (BFR) therapy during strengthening exercises.

Phase II — Weeks 2–6

Progressive WB & Strengthening

Brace & Weight Bearing

Advance to weight bearing as tolerated with crutches; continue tracker brace until adequate quad control. Ensure normal heel–toe gait. Can remove brace when sleeping.

ROM

Progress to full ROM as tolerated (flexion and extension).

Exercises

Patellar mobilisations
Sitting passive leg extension with roll under heel
Supine with legs up wall — heel slides (knee flexion) gravity-assisted
Bike pendulums: high seat ½ circles forward/backward → full circles — lower seat as tolerated
Progress 2 crutches → single crutch → full WB, maintaining normal walking pattern
Mini wall squat (30°) → progress to 60–90° (± wall)
Shuttle (one bungee cord): 2-leg squat (¼–½ range) and 2-leg calf raises → progress slowly to 1-leg, increasing ROM & resistance
Sit to stand 2 legs with high seat height (± muscle stimulation)
Supine on floor, legs on Swiss ball: bridging → bridging + knee flexion (heels to buttocks)
Wobble boards with support through full ROM: side-to-side, forward/backward

Modalities: Ice compression therapy and analgesics as needed to reduce pain and swelling. Compex/muscle stimulation to assist muscle activation. Blood flow restriction (BFR) therapy during strengthening exercises.

Phase III — Weeks 6–12

Advanced Strengthening

Brace & Weight Bearing

No brace. Full weight bearing. Ensure normal heel–toe gait.

ROM

Full and pain-free knee range of motion.

Exercises

Sit to stand 2 legs → progress by decreasing seat height
Bungee cord walking: forward / backward / side step with slow controlled return
Static lunge (¼–½ range) → dynamic lunge step (¼–½ range) with proper alignment (shoulders over knees over toes)
Step ups and down 2–4" height: lateral and forward
Wobble boards side-to-side, forward/backward: without support, without vision
Single leg stance 30–60 seconds (when full WB) → progress to unstable surface with and without vision
Cardiovascular fitness conditioning

Phase IV — 3–6+ Months

Return to Activity / Light Sport

Brace & Weight Bearing

As tolerated per surgeon guidance.

ROM

Full and pain-free.

Exercises

Progress resistance on shuttle: strength & endurance, 2 → 1 leg
Static lunge (full range) → dynamic lunge → lunge walking
Forward and lateral step-ups 4–6–8" (watch for hip hiking or excessive ankle dorsiflexion)
Eccentric lateral step-down on 2–4–6" step with control
Shuttle standing kick-backs (hip/knee extension)
Single leg stance on unstable surfaces (pillow, mini-tramp, BOSU, Airex, Dynadisc) with/without support → progress to no vision
Cardiovascular fitness conditioning
Sport-specific training as indicated

Modalities: Blood flow restriction (BFR) therapy during strengthening exercises.

* Timelines are approximate. Exercises are given as examples only and should be directed by your physiotherapist. Progression is criteria-based and directed by your physiotherapist in conjunction with Mr Getgood's clinical review. Individual recovery varies.

Frequently Asked Questions

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Supporting Evidence

Noteworthy Publications from Mr Getgood Pertaining to Osteotomy

Maniar AR, Mackay ND, Somerville L, Litchfield R, Lanting BA, Getgood AMJ. Improved clinical outcomes when maintaining a neutral joint line obliquity at high tibial osteotomy and subsequent total knee arthroplasty. J Exp Orthop. 2026;13(1):e70612.

Wackerle AM, Marcaccio S, Apseloff N, Getgood A, Musahl V, Tapasvi S, et al. Assessment and surgical correction of posterior tibial slope in revision anterior cruciate ligament surgery: An international expert Delphi consensus statement. J ISAKOS. 2025;13:100900.

Fritz J, Getgood A, van Heerwaarden R, Parratte S, Brown C, Tollefson LV, et al. Combined revision ACL reconstruction with slope-correction osteotomy and lateral extra-articular tenodesis improves stability in patients with high posterior tibial slope and pivot shift. J Exp Orthop. 2025;12(3):e70384.

Birmingham TB, Primeau CA, Moyer RF, Bryant DM, Ma J, Leitch KM, et al. High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis: A Randomized Trial With Parallel Preference Arm. Ann Intern Med. 2025;178(9):1238–48.

Vivacqua T, Thomassen S, Winkler PW, Lucidi GA, Rousseau-Saine A, Firth AD, et al. Closing-Wedge Posterior Tibial Slope-Reducing Osteotomy in Complex Revision ACL Reconstruction. Orthop J Sports Med. 2023;11(1):23259671221144786.

Sidhu R, Moatshe G, Firth A, Litchfield R, Getgood A. Low rates of serious complications but high rates of hardware removal after high tibial osteotomy with Tomofix locking plate. Knee Surg Sports Traumatol Arthrosc. 2021;29(10):3361–7.

Cotter EJ, Gowd AK, Bohl DD, Getgood A, Cole BJ, Frank RM. Medical Comorbidities and Functional Dependent Living Are Independent Risk Factors for Short-Term Complications Following Osteotomy Procedures about the Knee. Cartilage. 2020;11(4):423–30.

Getgood A, Collins B, Slynarski K, Kurowska E, Parker D, Engebretsen L, et al. Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):260–9.

Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, et al. A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):152–60.