When the knee is properly aligned, weight is distributed evenly across the joint. When alignment shifts — whether from genetics, injury, or arthritis — excess stress is placed on one side of the knee, which can accelerate cartilage wear and joint damage.
An osteotomy corrects this problem by carefully realigning the bone to redistribute weight away from the damaged area of the knee. The bone is then secured with a plate and/or screws while it heals. By reducing pressure on the affected portion of the joint, osteotomy can help relieve symptoms and preserve the natural knee.
What is osteotomy?
When the knee is properly aligned, weight is distributed evenly across the joint. In some patients, however, the alignment is off due to genetics, injury, or degeneration over time. This malalignment can place excessive stress on one side of the knee, increasing wear and accelerating joint damage.
An osteotomy corrects the alignment by cutting and repositioning the bone to redistribute weight across the knee. The bone is then secured with a plate while it heals. In many cases, the plate can be removed later in a simple outpatient procedure.
How osteotomy is performed
The location of the correction depends on where the alignment problem originates. The procedure may be performed in the upper tibia (high tibial osteotomy, HTO), the lower femur (distal femoral osteotomy, DFO), or at the tibial tubercle (tibial tubercle osteotomy, TTO), which is commonly used for kneecap maltracking and instability.
During the procedure, the bone is carefully cut and realigned to redistribute weight across the knee. The correction is then stabilized with a plate and screws while the bone heals.
Osteotomy is often combined with cartilage repair, meniscal transplantation, or ligament reconstruction to help protect those procedures and improve their long-term success.
Who is a candidate?
- Patients with malalignment (bow-legged or knock-kneed) that is overloading one compartment of the knee
- Younger, active patients with damage isolated to one compartment, where realignment can delay or avoid knee replacement
- Patients undergoing cartilage repair, meniscal transplantation, or ligament reconstruction whose alignment must be corrected to protect that procedure
Risks to understand
Osteotomy is a well-established joint-preservation procedure, but like any surgery it carries risks you should weigh with Dr. Gomoll — including infection, blood clots, delayed healing of the bone cut, hardware irritation that may warrant later plate removal, and the possibility that arthritis progresses over time despite realignment.
Recovery
Because the procedure involves a healing bone cut, recovery includes a period of protected weight-bearing, followed by progressive strengthening and return to activity over several months. The exact plan depends on the type of osteotomy and any procedures performed at the same time. See our rehab protocols and after-surgery instructions, and confirm your timeline with Dr. Gomoll.
Patient outcomes
- Jennifer — HTO + ACL reconstruction — a combined realignment-and-ligament case in a volleyball player
- More patient outcomes — written stories from realignment and combined joint-preservation cases
Frequently asked questions
What is a knee osteotomy?
A knee osteotomy is a realignment procedure. When the leg's alignment is off — from congenital shape, prior trauma, or degeneration — load is concentrated on one part of the knee and can accelerate wear. In an osteotomy the malaligned bone is cut and realigned, then held with a plate until it heals, shifting weight away from the damaged compartment.
Why correct alignment instead of replacing the knee?
When legs are straight, force across the knee is distributed evenly. Realignment can offload a damaged or repaired compartment and protect the joint, which is why osteotomy is often used in younger, active patients — frequently alongside cartilage repair, meniscus transplantation, or ligament reconstruction — to preserve the natural knee rather than move straight to replacement.
Does the plate stay in permanently?
The plate holds the realigned bone while it heals. It can later be removed in a simple outpatient procedure if it becomes bothersome, though many patients leave it in place. Dr. Gomoll will discuss what makes sense for you.
Is osteotomy often combined with other procedures?
Yes. Malalignment frequently accompanies cartilage damage, meniscal deficiency, or ligament injury. Correcting alignment at the same time as cartilage repair, meniscal transplantation, or ACL reconstruction protects that work and improves the durability of the result.
What is recovery from osteotomy like?
Recovery involves a period of protected weight-bearing while the bone cut heals, followed by progressive strengthening and return to activity over several months. The exact timeline depends on the type of osteotomy, whether other procedures were performed at the same time, and your healing — see our after-surgery and rehab pages, and confirm your plan with Dr. Gomoll.
Dr. Gomoll evaluates malalignment and performs knee realignment surgery at the Hospital for Special Surgery, 523 East 72nd Street on Manhattan's Upper East Side, caring for patients across New York City and beyond who want to preserve their natural knee. See our location and directions or request an appointment.
Medical disclaimer
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, and adherence to rehabilitation.