Knee Osteotomy in Sydney
A knee osteotomy realigns the leg to shift load away from the damaged side of the knee, relieving pain while preserving your own joint. It is often a strong option for younger, active people with arthritis or overload on one side of the knee.
What is knee osteotomy?
Knee osteotomy is joint-preserving realignment surgery. Instead of replacing the knee, the surgeon carefully cuts and repositions the tibia or femur to shift weight away from the painful, overloaded compartment and toward healthier cartilage.
Osteotomy is most commonly used when knee osteoarthritis affects one side of the knee. If the inner side of the knee is worn and the leg has a bow-legged alignment, a high tibial osteotomy may shift load toward the healthier outer side. If the outer side is worn and the leg has a knock-knee alignment, a distal femoral osteotomy may shift load toward the healthier inner side.
The aim is to reduce pain, improve function and delay the need for knee replacement surgery, especially in younger or active patients where replacing the joint too early may not be ideal.
Do you need a knee osteotomy?
Knee osteotomy may be worth considering if your pain comes mainly from one compartment of the knee and your leg alignment is placing extra load on that area. It is generally used for early to moderate single-compartment wear rather than widespread arthritis across the whole knee.
You may be a suitable candidate if you are active, have good knee movement, have functioning ligaments, have minimal arthritis in the other compartments and want to preserve your own joint for as long as possible. It is usually less suitable when arthritis affects the whole knee, the knee is very stiff, there is severe instability, or the symptoms are not mainly related to alignment and compartment overload.
Alignment matters. Two people can have similar-looking arthritis on an X-ray but need different treatment depending on where their weight-bearing line passes through the knee. Standing long-leg X-rays help show whether realignment could unload the painful compartment.
At your consultation, your surgeon will assess your symptoms, movement, ligament stability and imaging. You may need X-rays, standing long-leg alignment views and MRI to check the remaining cartilage, meniscus and ligaments before deciding whether osteotomy is appropriate.
Benefits and risks
What you can expect it to achieve
- Shift load away from the worn or painful side of the knee
- Reduce pain from single-compartment overload
- Preserve your own knee joint rather than replacing it
- Delay the need for partial knee replacement or total knee replacement in suitable patients
- Support a more active lifestyle than may be advised after joint replacement
- Correct bow-legged or knock-knee alignment where it is contributing to symptoms
- Allow combined treatment with ligament, meniscus or cartilage procedures in selected cases
Risks to understand
- Common and temporary: pain, swelling, bruising, stiffness and difficulty walking early in recovery
- General risks: infection, bleeding, blood clots, wound problems and anaesthetic complications
- Bone-healing risks: delayed union, non-union, fracture around the osteotomy or loss of correction
- Nerve and vessel risks: numbness around the incision is common; major nerve or blood vessel injury is rare
- Hardware-related: plates or screws can irritate soft tissues and may be removed after the bone has healed
- Longer-term: arthritis can still progress, and knee replacement may be needed later
All surgery carries risk and outcomes vary between individuals. Dr Jonathan Negus can discuss how these risks may apply to your knee. The goal of osteotomy is to buy useful time with your own knee, not to reverse arthritis completely.
Types of knee osteotomy
The type of osteotomy depends on which compartment is overloaded and where the alignment problem sits. A high tibial osteotomy is most common for bow-legged alignment and medial compartment wear. A distal femoral osteotomy is more often used for knock-knee alignment and lateral compartment wear.
A tibial tubercle osteotomy is different. It changes the position of the bony attachment of the patella tendon and is usually used for kneecap instability or patellofemoral overload rather than standard tibiofemoral arthritis.
| Type of osteotomy | What it is used for |
|---|---|
| High tibial osteotomy | Most commonly used for bow-legged alignment with inner compartment wear |
| Distal femoral osteotomy | Often used for knock-knee alignment with outer compartment wear |
| Opening wedge osteotomy | A controlled gap is opened in the bone and held with a plate, sometimes with bone graft |
| Closing wedge osteotomy | A wedge of bone is removed and the bone is closed into the corrected position |
| Tibial tubercle osteotomy | Used for selected kneecap instability or patellofemoral overload cases |
The procedure: what happens
Before surgery, your surgeon plans the correction using your examination and imaging. Standing long-leg X-rays are especially important because they show how weight travels from your hip through the knee to the ankle.
The operation is usually performed under general or spinal anaesthesia. Antibiotics are given to reduce infection risk, and the leg is cleaned and covered with sterile drapes. A tourniquet may be used around the upper thigh.
In an opening wedge osteotomy, the surgeon makes a controlled cut in the bone and opens a wedge to create the planned correction. The gap may be filled with bone graft or a bone substitute. A metal plate and screws hold the bone in its corrected position while it heals.
In a closing wedge osteotomy, a wedge of bone is removed and the bone ends are brought together into the corrected alignment. The bone is again secured with a plate, screws or other fixation.
Your surgeon may also perform arthroscopy or treat other issues such as meniscus, cartilage or ligament problems if they are part of the surgical plan. An X-ray is usually taken after surgery to confirm the correction and position of the metalwork.
After surgery
You will wake in recovery and be monitored until comfortable and stable. A physiotherapist will help you begin safe movement and teach you how to walk with crutches while protecting the healing bone.
Most patients go home once pain is controlled, they are moving safely and a rehabilitation plan is in place. This may be after one to two nights, although timing varies depending on the procedure, pain control and home support.
When to seek help. Contact us or seek urgent care if you develop fever, increasing calf pain or swelling, chest pain, shortness of breath, spreading redness, wound discharge, severe pain that is not improving, new numbness or weakness in the foot, or sudden loss of movement. Concerned about your recovery? Call (02) 9437 9794.
Knee osteotomy recovery and rehabilitation
Post-operative rehabilitation after knee osteotomy is staged because the bone needs time to heal in its new position. Many people use crutches for several weeks, and the amount of weight you can put through the leg increases gradually as your surgeon confirms healing.
Rehabilitation focuses on maintaining movement and strength while protecting the osteotomy. As the bone heals, the program progresses to walking quality, balance, strengthening, stairs, cycling and return to work or sport.
Recovery timeline
| Phase | Timeframe | What to expect |
|---|---|---|
| Protect & settle | Weeks 0–2 | Crutches, swelling control, wound care, gentle range-of-motion and early muscle activation |
| Protected loading | Weeks 2–6 | Gradual loading as advised, physiotherapy, movement work and maintaining quadriceps strength |
| Bone healing | Weeks 6–12 | Increasing weight-bearing if X-rays confirm healing, walking retraining and progressive strengthening |
| Strength & function | Months 3–6 | Strength, balance, cycling, longer walks and preparation for higher-level activity |
| Return to sport | Months 6–12 | Gradual return to sport-specific loading if bone healing, strength and symptoms allow |
Timeframes are a guide. Your progression depends on the correction, bone healing, X-rays, pain, swelling, strength and activity goals.
Post-operative care
Your dressings, brace use, crutch plan and weight-bearing limits will be explained before you leave hospital. It is important to follow the weight-bearing instructions closely because the bone needs time to heal.
Swelling, bruising and stiffness are common in the first month. Pain is usually managed with oral medication. X-rays are used during follow-up to check that the osteotomy is healing and that the plate and screws remain in the correct position.
Rehabilitation at MTP Health
This is where MTP Health is different. Your rehabilitation is delivered by our physiotherapists and exercise physiologists in the same clinic as your surgeon, with a plan that reflects your osteotomy type, correction size and sport or work goals.
Physiotherapy focuses on safe mobility, knee movement, swelling control and early strength. Exercise physiology becomes important as you return to heavier loading, gym work, running preparation or sport-specific movement.
Because osteotomy is a joint-preserving operation for active people, rehabilitation is not just about walking again. It is about building the strength and control needed to make the correction useful.
Returning to driving, work and sport
Driving depends on which leg was operated on, your crutch use, pain, medication use and ability to safely perform an emergency stop. Many people having right-sided surgery cannot drive until they are off crutches and have good control of the leg. Please check with your surgeon and insurer before driving.
Desk-based work may be possible within two to four weeks if pain, swelling and transport are manageable. Jobs involving heavy manual labour, long periods on your feet, uneven ground or ladders may require six weeks to three months or longer.
Many people return to low-impact activity once the bone has healed and strength has improved. Return to higher-impact sport may be possible in selected patients, often around six to twelve months, but should be guided by your surgeon, physiotherapist and objective strength and function targets.
Osteotomy is about load, not just pain. The surgery changes where force travels through your knee. The rehabilitation then teaches your leg to use that new alignment with strength, balance and confidence.
Knee osteotomy cost in Sydney
The cost of knee osteotomy depends on your private health cover, hospital insurance, surgeon fees, anaesthetist fees, assistant fees, implant or plate costs, bone graft or graft substitute costs and any additional procedures performed at the same time.
If you are having surgery using private health cover, you will receive a written quote before surgery once the planned procedure and hospital pathway are known. The anaesthetist is an independent practitioner and may charge a separate gap, so we provide their details and recommend checking their quote before committing to surgery.
The surgeons at MTP Health participate in various reduced-gap schemes run by different health insurance providers where available. Your insurer may also have an excess to pay, commonly around $500 depending on your policy.
If osteotomy is performed through the public system, there is no out-of-pocket surgical cost, but waiting times depend on hospital access, urgency category and local availability.
Why have your knee osteotomy at MTP Health
MTP Health brings together knee surgery specialists, physiotherapists and exercise physiologists in one clinic. That matters because osteotomy is a planning-heavy operation: the correction must match the alignment problem, and rehabilitation must protect the healing bone while rebuilding function.
Honest advice comes first. If your arthritis is too widespread for osteotomy, we will explain why. If non-surgical care is more appropriate, we will guide that. If osteotomy is suitable, we will help you understand the procedure, recovery, risks and expected outcome before you decide.
Your surgeon
Dr Jonathan Negus
Dr Negus is a fellowship-trained hip and knee surgeon who works alongside MTP Health's physiotherapy and exercise physiology team so your surgery and rehabilitation are managed as one plan.
View full profile →Frequently asked questions
How do I know if knee osteotomy might help my symptoms?
Osteotomy may be worth considering if your knee pain comes mainly from one compartment and your leg alignment is placing extra load on that area.
Imaging, such as standing long-leg X-rays, helps show whether the wear pattern and alignment might benefit from correction.
An assessment with a knee specialist can help clarify whether it suits your situation, especially if you are active and trying to delay knee replacement.
Is knee osteotomy an alternative to knee replacement?
For some people, yes. In early to moderate single-compartment wear with suitable alignment, osteotomy may help delay the need for a knee replacement by offloading the worn area.
It is generally not appropriate when arthritis affects the whole knee or when the joint is very stiff or unstable.
If arthritis is advanced across multiple compartments, a partial or total knee replacement may be more appropriate.
How long does recovery take after a knee osteotomy?
Recovery is staged and depends on the size of the correction, the osteotomy type and how the bone heals.
Many people use crutches for several weeks and build up activity gradually under physiotherapy guidance. Bone healing often takes several months.
Timelines differ from person to person, and your progression will usually be guided by symptoms, strength and follow-up X-rays.
Will I have metal plates in my leg permanently?
The plate and screws usually stay in place long term and often cause no problems.
Some people choose to have them removed once the bone has fully healed if they cause irritation, though removal is not always necessary.
If plate removal is recommended, it is usually a smaller operation than the original osteotomy.
Can I return to sport after a knee osteotomy?
Many people return to low-impact activity once healing is established, and a return to higher-impact sport may be possible depending on bone healing, alignment, strength and conditioning.
Your surgeon and physiotherapist can guide a safe, gradual progression suited to your sport and your knee.
Return to sport should be based on healing and function, not simply the date on the calendar.
What is the difference between high tibial osteotomy and distal femoral osteotomy?
A high tibial osteotomy changes alignment through the upper shin bone and is most commonly used for bow-legged alignment with inner compartment knee wear.
A distal femoral osteotomy changes alignment through the lower thigh bone and is commonly used for knock-knee alignment with outer compartment wear.
Will I need a knee replacement later?
Possibly. Osteotomy can delay the need for knee replacement, but it does not stop arthritis forever.
If arthritis progresses over time, a partial or total knee replacement may be considered later. The goal is often to preserve your own joint for as long as it remains useful and comfortable.
What happens if the bone does not heal?
Delayed healing or non-union can occur, although it is uncommon. Smoking, poor bone health, medical conditions and not following weight-bearing restrictions can increase the risk.
If the bone does not heal properly, further treatment may be needed, such as longer protection, bone stimulation, bone grafting or revision fixation.
Knee osteotomy consultations across Sydney
North Shore Health Hub, Level 4, Suite 401, 7 Westbourne St, St Leonards NSW 2065
St Leonards consulting →173 Warringah Road, Beacon Hill NSW 2100 — serving the Northern Beaches
Beacon Hill consulting →Also consulting at Gosford, Wahroonga, Castle Towers and Tamworth.
Talk to a surgeon about knee realignment
Book a consultation to find out whether knee osteotomy could help unload the painful side of your knee — and whether it is the right option before considering replacement surgery.
Book a ConsultationPrefer to talk? Call (02) 9437 9794 · GP & physio referrals: referrer information
- American Academy of Orthopaedic Surgeons, Osteotomy of the Knee patient guidance.
- Sydney Knee Specialists, Knee Osteotomy patient information.
- Current knee osteotomy literature and rehabilitation guidance for high tibial osteotomy and distal femoral osteotomy.