An osteotomy is a surgery in which a surgeon cuts a bone, changes its angle and fixes it in the new position so that body weight passes through the healthier part of a joint. It keeps your own joint, keeps it moving, and can relieve pain for many years. For younger, active people with arthritis on one side of the knee, hip or ankle, osteotomy is often the best way to buy time before a joint replacement, or to avoid one altogether.

If your orthopedic surgeon has suggested an osteotomy, this guide explains what it is, the main types, who it suits, what rehab looks like week by week, and what results you can realistically expect. It is written for patients and families and is not a substitute for a personal examination.

Key takeaways

Osteotomy is joint preservation surgery: it corrects alignment instead of replacing the joint.
It works best for people under about 60 who are active, of healthy weight and have arthritis limited to one part of the joint.
High tibial osteotomy (HTO) for bow legs is the most common type.
Bone healing usually takes about four to six months. Most patients walk without aids by around three months.
Large reviews show that most knee osteotomies are still working 10 years later, and many last 15 to 20 years.
Osteotomy does not cure arthritis, but it can delay knee replacement by years.

What is an osteotomy?

The word comes from "osteo" (bone) and "tomy" (cutting). In an osteotomy, the surgeon makes a planned cut in a bone near a joint, changes the angle of the bone, and holds it with a plate and screws while it heals.

The idea is simple. In a leg that is bowed (varus), body weight passes mostly through the inner side of the knee. That side wears out first, while the outer side stays healthy. Straightening the leg by a few degrees moves the weight-bearing line towards the healthy side. The worn side is unloaded, pain falls, and the remaining cartilage is protected.

There are two basic techniques:

Opening wedge: The bone is cut on one side and gently opened like a hinge. The gap is held with a plate and may be filled with bone graft or a bone substitute.
Closing wedge: A small wedge of bone is removed from the opposite side and the gap is closed, then fixed with a plate or staples.

Your surgeon chooses the technique based on the size of the correction, your bone quality, the state of your ligaments and kneecap, and their own experience.

Types of osteotomy

Type	Bone	Joint protected	Common reason
High tibial osteotomy (HTO)	Shin bone, just below the knee	Knee	Bow legs with arthritis on the inner side of the knee
Distal femoral osteotomy (DFO)	Thigh bone, just above the knee	Knee	Knock knees with arthritis on the outer side of the knee
Double-level osteotomy	Thigh and shin bones	Knee	Large deformities that cannot be corrected safely at one level
Tibial tubercle osteotomy	Bony bump below the kneecap	Kneecap (patellofemoral) joint	Kneecap dislocation, maltracking or kneecap arthritis
Periacetabular osteotomy (PAO)	Pelvis around the hip socket	Hip	Hip dysplasia (shallow socket) in young adults
Femoral osteotomy	Upper thigh bone	Hip	Some hip deformities and childhood hip conditions
Supramalleolar osteotomy (SMO)	Lower shin bone above the ankle	Ankle	Ankle arthritis worse on one side, tilted ankle
Calcaneal osteotomy	Heel bone	Foot and ankle	Flatfoot or high-arch (cavus) foot
Corrective osteotomy for malunion	Any long bone, wrist or forearm	Nearby joint	A fracture that healed in a bad position

High tibial osteotomy (HTO)

HTO is the most common and most studied osteotomy. It is used for bow legs with arthritis or overload on the inner (medial) side of the knee. It is also used along with ligament or cartilage surgery when poor alignment would make those repairs fail.

Distal femoral osteotomy (DFO)

DFO is used for knock knees (valgus), where the outer (lateral) side of the knee wears out. It is also used to protect a cartilage repair or meniscus transplant on the outer side.

Tibial tubercle osteotomy

This shifts the bony attachment of the kneecap tendon. It helps patients whose kneecap slips out of place repeatedly, or whose kneecap cartilage is overloaded.

Hip osteotomy

Periacetabular osteotomy reorients a shallow hip socket so that it covers the ball of the hip better. It is mainly offered to adolescents and young adults with hip dysplasia before significant arthritis sets in.

Ankle and foot osteotomy

Supramalleolar osteotomy corrects a tilted ankle so that weight passes through the healthier part of the joint. Calcaneal (heel bone) osteotomy realigns the heel in flatfoot and high-arch deformities and is often combined with tendon procedures.

Corrective osteotomy for malunion

When a fracture heals crooked, the nearby joint is loaded unevenly and can wear early. A corrective osteotomy re-cuts the bone and fixes it in the right position. This is common after old fractures of the shin, thigh, forearm and wrist.

Indications: who is a good candidate?

Osteotomy is usually considered when:

Arthritis or cartilage damage is limited to one part of the joint
There is a measurable deformity, such as bow legs, knock knees or a tilted ankle
The joint still bends and straightens well
The knee ligaments are stable, or will be reconstructed at the same time
Pain continues despite physiotherapy, weight management, medicines, braces or injections

The ideal patient is:

Younger, typically in their 30s, 40s or 50s, though active people in their early 60s may also qualify
Physically active, with work or sport that demands a lot from the joint
Of healthy weight
A non-smoker, or willing to stop before surgery
Motivated to follow a structured rehab programme

When osteotomy may not be suitable

Arthritis across the whole joint (more than one compartment of the knee)
Inflammatory arthritis, such as rheumatoid arthritis
A very stiff joint or a knee that cannot straighten fully
Severe obesity, poorly controlled diabetes or poor circulation
Heavy smoking, which slows bone healing
Very advanced arthritis where little healthy cartilage remains

In these situations a joint replacement or another option may give a more reliable result.

How surgeons plan an osteotomy

Accurate planning is what makes an osteotomy succeed. Your surgeon will usually ask for:

Full-length standing X-rays of the whole leg, to measure the weight-bearing line and the exact angle of correction
MRI, to check cartilage, meniscus and ligaments
CT scan, for some hip, ankle and complex deformities
Sometimes an arthroscopy (keyhole look inside the joint), which may be done at the same time as the osteotomy

The surgeon then calculates how many degrees of correction are needed and where the new weight-bearing line should fall. Over-correcting or under-correcting can both affect the result, so this step is critical. Some centres use computer navigation or patient-specific 3D-printed guides to improve accuracy.

What happens during surgery?

Anaesthesia is given, usually spinal or general.
An arthroscopy may be done first to treat the meniscus or cartilage.
A small incision is made over the bone to be cut.
Under X-ray guidance, the bone is cut in a planned line.
The bone is opened or closed to the target angle.
A plate and screws hold the position. A bone graft or substitute may fill an opening wedge.
The wound is closed and the limb is placed in a brace.

Most osteotomies take one to two hours. Many patients stay in hospital for two to four days.

Osteotomy combined with other procedures

Alignment matters for every structure inside the joint. Osteotomy is therefore often combined with:

ACL reconstruction, especially in bow-legged knees or when a previous reconstruction has failed
Cartilage repair or regeneration, to protect the new cartilage from overload
Meniscal repair or meniscus transplant
Kneecap stabilisation, together with a tibial tubercle osteotomy

In these cases the osteotomy fixes the load on the joint and the other procedure fixes the damaged structure.

Rehabilitation after osteotomy

Rehab is just as important as the surgery. Your surgeon and physiotherapist will tailor the plan to the type of osteotomy, the fixation used and how your bone is healing. The ranges below are a general guide for knee osteotomy.

Phase	Timing	Goals and activities
Protection	Weeks 0 to 2	Pain control, ice and elevation, wound care, brace, ankle pumps, quadriceps setting, gentle knee bending as advised, crutches
Early motion	Weeks 2 to 6	Full knee straightening, bending to about 90 degrees and beyond, partial weight bearing with crutches as allowed, stationary exercise for the other leg
Loading	Weeks 6 to 12	X-ray check for healing, gradual progress to full weight bearing, weaning off crutches, stationary cycling, balance and gait training
Strengthening	Months 3 to 6	Walking without aids, strengthening of thigh and hip muscles, stairs, swimming, light gym work
Return to activity	After 6 months	Return to recreational sport for suitable patients once the bone has fully healed and the surgeon clears it

Hip and ankle osteotomies follow a similar pattern, though PAO and some ankle procedures need a longer period of protected weight bearing.

Practical rehab tips

Follow weight-bearing instructions exactly. Putting full weight on the leg too early can cause the bone to shift or the plate to fail.
Do your exercises daily, not just on physiotherapy days.
Take the medicines prescribed to prevent blood clots.
Stop smoking completely. It is one of the biggest causes of delayed healing.
Eat enough protein and take calcium and vitamin D if advised.
Most people return to desk work at about four to six weeks and to physical work at about three to six months. Driving depends on which leg was operated on and when you can brake safely.

Our physiotherapy and sports rehabilitation team plans strengthening, gait training and a safe return to sport for each patient.

Outcomes: how well does osteotomy work?

Most of the long-term evidence comes from high tibial osteotomy.

Survival over time: A systematic review of 69 studies covering 4,557 patients found that 92.4% of isolated HTOs were still working (not converted to knee replacement) at 5 years, 84.5% at 10 years, 77.3% at 15 years and 72.3% at 20 years.
Technique: A 2017 meta-analysis reported 10-year survival of 91.6% for opening wedge HTO and 85.4% for closing wedge HTO. The authors noted some publication bias at 10 years, so this difference should be read with caution.
Advanced arthritis: Even in patients whose X-rays showed advanced arthritis on the inner side of the knee, a 2024 review of 18 studies (1,296 knees) found average 10-year survival of 74.6%, with a wide range between studies.
Function: Most patients report less pain and better walking. Many return to recreational sport such as cycling, swimming, hiking and doubles tennis. Benefits tend to decline slowly over time as arthritis progresses.

Factors linked to better results

Younger age and healthy weight
Arthritis limited to one compartment, with good motion before surgery
Accurate correction of the angle
Solid bone healing
Commitment to rehab and to staying active

If you need a knee replacement later

If arthritis eventually progresses, a knee replacement can still be done after an osteotomy. The surgery may be slightly more complex because of the previous incision, the changed bone shape and, sometimes, the need to remove the plate. Experienced surgeons plan for this.

Osteotomy vs knee replacement

	Osteotomy	Knee replacement
What it does	Realigns your own bone to unload the worn side	Replaces worn joint surfaces with metal and plastic
Best for	Younger, active patients with one-sided arthritis	Older patients or arthritis across the whole knee
Joint kept	Yes	No
Activity limits afterwards	Few, once healed	Usually avoid high-impact sport
Recovery	Slower early recovery because bone must heal	Faster early walking
Long-term	May need a replacement later	Implant may need revision after many years

Neither is better for everyone. For a 45-year-old with bow legs and early arthritis, osteotomy may give 10 to 15 good years without the restrictions of an implant. For a 70-year-old with arthritis throughout the knee, a replacement is usually more reliable.

Risks and complications

All surgery carries risks. Your surgeon should explain these before you consent.

Infection
Bleeding and blood clots (deep vein thrombosis)
Nerve or blood vessel injury
Delayed union or nonunion of the cut bone
A crack through the hinge of the bone during an opening wedge correction
Over-correction or under-correction of the angle
Loss of correction if the bone shifts before healing
Hardware irritation, sometimes needing plate removal later
Stiffness
Return of symptoms as arthritis progresses
Need for joint replacement in future

You can lower many of these risks by stopping tobacco, controlling blood sugar, correcting vitamin D deficiency, reaching a healthier weight and following weight-bearing instructions exactly.

Osteotomy in India: practical points

Squatting and floor sitting. Many Indian patients value deep knee bending for prayer, Indian-style toilets and sitting on the floor. Because osteotomy keeps your own joint, it usually preserves more of this motion than a joint replacement. Discuss your daily needs with your surgeon.

Bow legs are common. Varus (bow-legged) alignment and inner-side knee arthritis are frequently seen in Indian patients, which makes HTO highly relevant.

Vitamin D and bone health. Vitamin D deficiency is very common across India, even in sunny cities. A blood test and supplements before surgery are often sensible.

Diabetes. Poorly controlled blood sugar raises the risk of infection and slow bone healing. Good control before surgery improves outcomes.

Post-injury deformity. Old fractures that healed crooked are common and often affect people in their 30s and 40s. Corrective osteotomy can protect the joint before arthritis sets in.

Second opinions. If you have been told that a replacement is your only choice, a second opinion from a surgeon who offers both joint-preserving and joint-replacement options is reasonable. At Sports Orthopedics Institute, Dr Naveen Kumar L V regularly reviews reports and explains all surgical and non-surgical options clearly.

Alternatives to consider first

Not every painful joint needs bone surgery. Depending on your diagnosis, options may include:

Physiotherapy and strengthening
Weight loss and activity modification
Anti-inflammatory medicines
Unloader braces and lateral-wedge insoles
Injections as advised by your doctor
Arthroscopy to treat cartilage, meniscus or loose bodies
Total knee replacement, robotic knee replacement or total hip replacement when the joint is badly worn

For sports injuries that can lead to early arthritis, such as a torn ligament or meniscus, timely treatment such as ACL reconstruction or meniscal repair may protect the joint and avoid bigger surgery later.

Questions to ask your surgeon

What is my exact diagnosis, and which part of the joint is damaged?
How much deformity do I have, and how many degrees will you correct?
Will you use an opening or closing wedge, and why?
Do I need any other procedure at the same time?
How many osteotomies do you perform each year?
When can I put full weight on my leg, drive, climb stairs and return to work?
How long is this osteotomy likely to last for someone like me?
Will the plate need to be removed later?

When should you see an orthopedic specialist?

Book a consultation if you have:

Knee, hip or ankle pain that lasts more than a few weeks or wakes you at night
A visible bow leg, knock knee, flatfoot or limb deformity
Pain on one side of the knee that gets worse with walking or stairs
Pain after an old fracture that healed in a bad position
Repeated kneecap dislocations
A recommendation for joint replacement at a young age and you want a second opinion

Early assessment keeps more options open.

Expert osteotomy care at Sports Orthopedics Institute, Bangalore

Sports Orthopedics Institute in HSR Layout, Bengaluru is led by Dr Naveen Kumar L V, a senior orthopedic and sports surgeon with 27+ years of experience and extensive training in India and the UK. The team focuses on accurate diagnosis with minimal tests, clear patient education, and treatment plans that match your age, work and sporting goals.

You can explore all conditions and treatments here, or book an appointment for an assessment or a second opinion. Please bring your previous X-rays, MRI scans, a list of medicines and a photo ID.

Frequently asked questions

1. What is osteotomy surgery?

Osteotomy is a surgery in which a bone is cut, realigned and fixed with a plate so that weight passes through the healthier part of a joint. It relieves pain and protects the joint while keeping it moving.

2. What are the main types of osteotomy?

The main types are high tibial osteotomy and distal femoral osteotomy for the knee, tibial tubercle osteotomy for the kneecap, periacetabular and femoral osteotomy for the hip, supramalleolar osteotomy for the ankle, calcaneal osteotomy for the foot, and corrective osteotomy for badly healed fractures.

3. Who is a good candidate for knee osteotomy?

Usually a person under about 60 who is active, of healthy weight, has good knee motion and has arthritis limited to one side of the knee with bow legs or knock knees.

4. How long does it take to recover from an osteotomy?

Bone healing typically takes about four to six months. Most patients use crutches for six to eight weeks and walk without aids by around three months. Return to sport usually takes six months or more.

5. How long does a high tibial osteotomy last?

In a large review, about 85% of HTOs were still working at 10 years and about 72% at 20 years. Results depend on age, weight, the stage of arthritis and accurate correction.

6. Is osteotomy better than knee replacement?

Osteotomy suits younger, active patients with one-sided arthritis because it keeps the natural knee and has fewer activity limits. Knee replacement is generally more reliable for older patients with arthritis throughout the knee.

7. Does osteotomy cure arthritis?

No. It reduces pain and slows wear by changing how weight is carried, but the arthritis remains. It often delays the need for joint replacement by several years.

8. Is osteotomy surgery painful?

There is pain in the first few weeks, controlled with medicines, ice, elevation and a brace. Most patients find the pain settles steadily as the bone heals.

9. Can I squat or sit cross-legged after osteotomy?

Many patients regain deep bending once the bone has healed and rehab is complete, because the natural joint is preserved. Your surgeon will advise when it is safe to try.

10. Will the plate need to be removed?

Not always. The plate is removed only if it irritates the soft tissues, or sometimes at the time of a later knee replacement.

11. Where can I get an osteotomy opinion in Bangalore?

You can book a consultation at Sports Orthopedics Institute in HSR Layout, Bengaluru for assessment, second opinions and treatment planning.

Resources and further reading

Nebraska Medicine: Knee arthritis surgery, replacement or osteotomy: https://nebraskamed.com/node/26861
Warner Orthopedics: Ankle arthritis and realignment osteotomy: https://warnerorthopedics.com/ankle-arthritis-and-realignment-osteotomy/
Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis (Scientific Reports, 2017): https://pmc.ncbi.nlm.nih.gov/articles/PMC5544741/
Results of high tibial osteotomy: review of the literature (International Orthopaedics, 2010): https://pmc.ncbi.nlm.nih.gov/articles/PMC2899364/
High survivorship and good clinical outcomes after HTO in advanced medial knee osteoarthritis: a systematic review (Archives of Orthopaedic and Trauma Surgery, 2024): https://link.springer.com/article/10.1007/s00402-024-05254-0
Systematic review of HTO survival, 69 studies (Healio Orthopedics, 2013): https://cm.healio.com/news/orthopedics/20130430/harris_10_3928_1081_597x_20130401_01_1134722

Disclaimer: This article is for general education and does not replace advice from a qualified orthopedic surgeon. Please consult a doctor for diagnosis and treatment.

Osteotomy Surgery: Types, Indications, Rehab and Outcomes