Realigning your knees with the bilateral HTO procedure: benefits, risks and recovery

Written by: Mr Matt Dawson
Published: | Updated: 26/10/2023
Edited by: Cameron Gibson-Watt

Bilateral HTO (high tibial osteotomy) corrects the alignment of both your knee joints, relieving symptoms such as knee pain and stiffness and preventing possible further damage to your joints. If you are a particularly active person and want to maintain your level of activity, then this surgery would be a good choice.
Mr Matt Dawson is a leading orthopaedic surgeon specialising in sports injuries and degenerative conditions. Outside of Japan, he also has the most extensive experience of bilateral osteotomy surgery anywhere in the world. We spoke to him about this procedure to give us a quick overview of the risks and benefits and what you can expect if you choose to undergo this treatment.


When is a bilateral HTO performed?

High tibial osteotomy (HTO) is a surgical procedure that realigns the leg to redistribute your weight across the knee and protect the damaged part of the joint. It is typically done to preserve the inner part of the joint and to relieve symptoms such as pain and stiffness in the knee.

Osteotomy is usually used to treat osteoarthritis, however, it can also be considered if there are other types of damage such as ligament injury.

If you are experiencing knee pain and stiffness when you are playing sports, then this procedure can help fix this problem and allow you to continue playing sports without further damaging your knees. It can also help to reduce your chances of having to undergo a knee replacement later down the line.


Can both knees be operated on at the same time?

Yes, this is known as a bilateral HTO and can be offered if you are experiencing symptoms in both knees. By operating on both sides during one procedure, it reduces your overall recovery time.


What happens during a bilateral HTO?

During bilateral HTO surgery, incisions are made at the top of the shin bones and bone grafts of a specific size are fitted into a gap created by opening a wedge shape. The new alignment is then fixed with titanium surgical plates. The entire procedure is carefully planned beforehand so that we can ensure your weight is evenly distributed across the joints.


What is recovery like from a bilateral HTO?

You will have to spend at least two nights in the hospital after undergoing a bilateral HTO. You will also need to use a wheelchair once you go home for up to 4 weeks. In addition, we can provide you with a banana board: a yellow lightweight, curved board to help you transfer yourself while in a seated position from one place to another.

You will not be able to put full weight through your legs for the first 4 weeks, so the use of specially designed crutches will help you get around and make short distances. You should use these for at least 8 weeks and avoid any manual-style work for 3-4 months. Physiotherapy is highly recommended and a very important aspect of your recovery. Therefore, you should try to schedule this even before undergoing the operation.

You can expect to return to all of your usual daily activities including playing sports after you have fully recovered. It is important to note that even though you may experience quicker pain relief during the recovery from a total or partial knee replacement, the overall benefits of HTO far outweigh the benefits of a knee replacement in terms of levels of activity and flexibility you can achieve after recovery and preservation of the knee joint in the medium to longer term.


What are the risks and benefits of this procedure?

As with any surgery, there are always small risks of complications occurring. This may include infections, blood clots and adverse reactions to the anaesthesia. There are a number of significant benefits from undergoing a bilateral HTO which should be noted:

  • The operation helps to relieve significant pain and stiffness in the knee joint.
  • The pressure placed on the knee joint is reduced, which should consequently reduce the chances of further damage to your bones and cartilage.
  • Correcting both knees can help to improve your stride and correct bow legs - where the legs curve outwards at the knees.


Mr Matt Dawson is available for both face-to-face appointments and video consultations. To make an appointment with him to discuss more this procedure, visit his Top Doctors profile and check his availability.

By Mr Matt Dawson
Orthopaedic surgery

Mr Matt Dawson is a highly skilled orthopaedic surgeon who specialises in sports injuries and degenerative conditions affecting the knee. His areas of expertise include; knee osteotomy, knee ligament reconstruction, joint replacement, partial joint replacement, arthroscopy and cartilage reconstruction. His private clinics are based at The Cumbrian Knee Clinic Penrith, Nuffield Health Newcastle Upon Tyne HospitalRamsay Fulwood Hall Hospital Preston and BMI The Lancaster Hospital. He is a global leader in the field of osteotomy, having developed one of the largest UK practises in osteotomy of the knee, and has one of the largest single surgeon series in the UK. 

Mr Dawson completed his orthopaedic training in London and a sports knee fellowship in Dublin before he joined North Cumbria University NHS Hospital, where he has worked since 2001.  During these years he has been clinical director and is the knee surgery lead. He also provides one of the largest unicondylar (partial) knee replacement services in the North of England, having carried out over 300 of these procedures. He uses gold standard implants for both partial and full knee replacements and the National Joint Registry confirms his good results.

Mr Dawson has developed one of the largest European practices in Osteotomy surgery, with around 600 cases to date. This includes a wide range of osteotomy, incorporating combined complex procedures for deformity and instability.

Mr Dawson is a leading educator in the field of osteotomy and joint preservation. He hosts a successful fellowship in osteotomy and knee surgery at North Cumbria University Hospital and lectures locally, nationally and internationally. Mr Dawson also hosts an annual international masterclass at St James Park, Newcastle upon Tyne, where he is joined by internationally recognised experts. He is a founding member of UKKOR, the world’s first national osteotomy registry. From 2018 to 2022 he has been elected the Chair of the leading European Sports Knee Surgery and Arthroscopy Society, ESSKA’s Osteotomy Committee.

Mr Dawson is undertakes research and his work has been published in numerous peer-reviewed journals on the subject of osteotomy and knee surgery. Currently, he is collaborating with various international companies in increasing accuracy in osteotomy surgery. 

View Profile

Overall assessment of their patients

  • Related procedures
  • Platelet-rich plasma
    Ozone therapy
    Botulinum toxin (Botox™)
    Abnormal gait
    Epicondylitis (tennis elbow)
    Elbow Pain
    Nerve Compression elbow
    Median nerve compression
    Radial nerve compression
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.