Femur or tibia — when osteotomy is considered

Per AAOS guidance, knee osteotomy reshapes either the tibia or the femur — not the hip joint itself. It works best when one knee compartment is overloaded and the rest still has usable cartilage, typically in active patients who are too young or too active for early total knee replacement.

  • High tibial osteotomy (HTO) — proximal tibia cut, often for varus (bow-leg) with medial compartment overload
  • Distal femoral osteotomy (DFO) — distal femur cut, often for valgus (knock-knee) with lateral compartment overload
  • Double-level planning when deformity involves both femur and tibia
  • Malalignment after prior injury or meniscus loss
  • Combined planning with ACL, meniscus, or cartilage procedures when needed

How planning works

Accurate planning matters more than the hardware brand. Standing long-leg (hip-to-ankle) alignment X-rays, knee films, and sometimes CT or MRI define where the deformity lives, the correction angle, hinge point, and whether opening- or closing-wedge osteotomy fits your anatomy.

You leave with a clear explanation of expected correction, bone healing time, weight-bearing limits, and when physiotherapy progresses from protection to strength.

  • Standing hip-to-ankle alignment series and targeted MRI/X-ray review
  • Correction goal matched to your activity and cartilage status
  • Discussion of plates, screws, and graft (when used in opening-wedge work)
  • Honest comparison with injection therapy, unloading braces, or knee replacement

Recovery expectations

Bone needs time to heal. Early weeks focus on swelling control, protected weight-bearing, and maintaining motion. Strength and sport-specific loading return in stages — usually months, not weeks — with checkpoints before running or pivoting.

Fellowship-backed decision making

Dr Ala' Hawa's Australian fellowships in knee sports medicine and joint replacement support osteotomy decisions that sit between sports surgery and arthroplasty — choosing femur/tibia preservation when it is realistic, and knee replacement when it is not.

Other specialist areas

Common questions

What is an osteotomy?

Osteotomy is a controlled bone cut. For knee realignment, the cut is made in the tibia (high tibial osteotomy / HTO) or the femur (distal femoral osteotomy / DFO) so force shifts off a worn compartment onto healthier cartilage — the goal is the knee; the bone cut is in the shin or thigh.

Who is a good candidate for knee osteotomy?

Typically active patients with malalignment and arthritis mainly in one compartment, who still have usable cartilage elsewhere and want to delay total knee replacement. Severe multi-compartment arthritis usually favours replacement instead.

Is the cut in the hip, or in the femur and tibia?

For standard knee realignment osteotomy, the bone cut is in the proximal tibia and/or distal femur — not through the hip joint. Which bone is chosen depends on where the deformity originates on long-leg X-rays.

How long is recovery after osteotomy?

Bone healing usually takes several months. Protected weight-bearing, swelling control, and staged physiotherapy come first; running or pivoting sports return only after strength and imaging checkpoints — not on a fixed calendar alone.

Will I need a plate and screws?

Most modern osteotomies are fixed with a plate and screws so the correction holds while bone heals. Hardware is usually left in place unless it bothers you later.

Can osteotomy be combined with ACL or meniscus surgery?

Yes, when instability or meniscus pathology coexists with malalignment. Combined or staged plans are individualised after examining the knee and reviewing MRI and alignment films.