What is a knee osteotomy?
An osteotomy realigns the knee by cutting and precisely adjusting the angle of the bone above or below the joint, shifting weight-bearing load away from an arthritic or damaged compartment and onto healthier cartilage. It's a joint-preserving alternative to replacement for the right patient — typically younger or active patients whose damage is confined to one compartment and driven by malalignment.
The three osteotomies
- High tibial osteotomy (HTO) — corrects alignment through the upper tibia, most often for bow-legged (varus) alignment overloading the inner compartment.
- Distal femoral osteotomy (DFO) — corrects alignment through the lower femur, used when malalignment is centered above the knee, typically knock-kneed (valgus) alignment overloading the outer compartment.
- Tibial tubercle osteotomy (TTO) — repositions the bony attachment of the patellar tendon to improve kneecap tracking and unload the cartilage behind the patella; often combined with MPFL reconstruction or cartilage restoration.
Pre-operative planning with full-length alignment X-rays targets a precise, individualized correction. Osteotomy is frequently paired with cartilage restoration or meniscal transplant so the newly protected compartment can heal.
Why choose osteotomy over replacement?
Osteotomy preserves your native joint. That means no implant wear concerns, and continued participation in higher-demand activity that would be discouraged after a replacement. It can meaningfully reduce pain by redistributing load, and it delays — sometimes avoids — the need for knee replacement. If a replacement is eventually needed, it remains an option later. For patients who are better served by replacement now, see the Mako robotic knee replacement guide.
Recovery timeline
Because the bone must heal in its corrected position, early recovery is more protective than after arthroscopy: protected, limited weight-bearing for the first 6 weeks with crutches, progressive weight-bearing over weeks 6–12 as X-rays confirm healing, strengthening and return to daily activity by months 4–6, and return to higher-demand activity around months 6–9.
Frequently asked questions
Is this the same as a knee replacement?
No — osteotomy preserves your native joint by realigning it, rather than replacing the joint surfaces. It's specifically aimed at younger or active patients who want to keep their own knee.
Will I need a knee replacement eventually?
Osteotomy can delay the need for replacement significantly, though some patients may still need one later in life. Importantly, having an osteotomy does not burn that bridge.
How is HTO different from DFO?
Both realign the knee — HTO adjusts the tibia (below the knee) and DFO adjusts the femur (above it), depending on where your malalignment originates.
How long until the bone is fully healed?
Bone healing typically takes around 3 months, monitored with follow-up X-rays before activity is advanced.
See Dr. Pettit
5 locations across Cincinnati & Northern Kentucky · (513) 354-3700