Pain-free bilateral simultaneous HTO


Katie has just done so well after bilateral simultaneous high tibial osteotomy surgery.

Katie is a very pleasant 50 year old lady who was working as a shop manager - she has an interesting history in terms of her work, having achieved an MBA in business and a law degree and has also worked in healthcare. She presented to me with bilateral medial knee pain which she has had since she was a teenager and she has also always been aware that her knees were really quite bowed (or varus). Her knee pain had begun to get worse two years prior to seeing me and standing and working in the shop really made the pain quite significant and was associated with swelling.

One of the main problems that Katie had was that she really did not like the appearance of her legs which were significantly bowed. She wanted to get something done about this, so she came to see me because of my expertise in realignment osteotomy surgery. Having gone through the process of pre-operative planning underwent bilateral simultaneous osteotomy surgery on the 11th of April.

Osteotomy on both sides at same time

We did a symmetrical procedure, doing 4cm longitudinal incisions on both sides just below the knee on the inner aspect, and did an 8.3mm correction on the left and 5.5mm on the right - and Katie has done very well. 

When I went to see her the following day she actually didn't think she had had an operation as she had experienced no pain whatsoever since the time of waking up from surgery.

She was able to get to the bathroom comfortably and had no pain for the first 2-3 days, and then minor amounts of pain which she wrote as 3 out of 10 at its worst, and she has managed with the odd painkiller. When I saw her today, she was walking comfortably, and could manage to fully weight-bear without crutches. Her wounds have healed beautifully and you can see from the videos that she has not only an excellent gait but also small incisions and an excellent range of motion at this early stage.

scar after hto
scar after hto

Advances in minimally-invasive surgery

I think with the advances that we have made in minimally-invasive osteotomy surgery - particularly with the use of a femoral head bone wedge - with the accurate pre-operative digital planning that we are doing and the use of a GameReady cryotherapy device, together with the different types of anaesthetic that we use in terms of spinal and large volumes of local anaesthetic in and around targeted areas, we can achieve an operation that previously was very painful that can end in a good example like this, leaving the patient with no pain. 

Adrian Wilson

Adrian Wilson

Obviously it is interesting that both tibias were done at the same time and we have seen such symmetrical excellent results in both. I think this is a testament to the new procedures that we have developed.

I can’t remember the first time I realised that my legs were ‘different’.  I think it was my early teenage years but I do remembered being teased mercilessly about them.
When I was 20 I somehow broke my metatarsal bones in both feet , during my recovery I mentioned to my GP about my bow legs having contributed to my feet problems and he referred me to an orthopaedic surgeon who, having asked me to parade up and down in front of all to his team of medics, simply told me that nothing could be done for my legs and that I just ‘wouldn’t win a miss
leg competition’. Needless to say my legs went firmly underneath a pair or trousers and pretty much never came out again ! One thing though, I didn’t agree with his analysis of the situation . I was pretty sure that given my anatomical set up this would cause wear and tear - in particular my knees.
Over the years and thanks to the internet I kept an eye on advancements in medical procedures. I also sensed that my body was struggling, I had back pain, feet pain neck pain etc. I tried keeping myself fit with walking and pilates but always felt that if only my legs could be re-aligned then I
could tackle my aches and pains head on. I have attended physios and chiropractors and although I discussed my alignment to them they understandably worked with what they had so I was always
left feeling…if only....
About 18 months ago I came across Professor Wilson’s website and his words resonated with me. I
met Professor Wilson who of course listened to me and for the first time ever understood my problems , not just physical but the psychological aspect too. He is such a leader in this field, I knew as soon as I found him I was in the best possible hands.
Professor Wilson and I had quite a few appointment discussing the various options of treatment that were available to me and on April 11th he carried out a bilateral high tibial osteotomy with a spinal anaesthetic and light general anaesthetic. The operation went very smoothly and I spent 3 nights in
hospital . I felt absolutely no pain for the first few days , getting up for a shower the morning after the operation and walking with my 2 crutches. I had no idea mobilisation would be this fast or this
painless. The pain did kick in a bit around Day 3 but I was prescribed stronger analgesia which I took.
I was also attached to my Game Ready Machine which really was brilliant at reducing the swelling.
It is a big ask going for the bilateral though I felt sure I would cope with it and I booked into the Clavedel (a post op rehab centre) for a week once I was discharged from hospital. It is the most wonderful sanctuary of care and it allowed me to focus on my hydrotherapy and physio The whole set up at the Clavedel is first class and it really suited me as I was going back to pretty much living on my own.
At the time of writing this I am 4 weeks post op. the rest of my bruising has come out and now
fading away, my scars are so neat and the swelling all but gone. I am on occasional paracetamol and
am working really hard at physio but also getting loads of rest . I didn’t anticipate how tired I would be, so it’s wonderful excuse to opt out for a bit and concentrate on you ! I stayed at the Clavedel for
2 weeks, a real treat and then a further 2 weeks with a nursing friend. At 4 weeks post op I am
walking well and am getting stronger each day. I am ready to return home with a network of friends ready and willing to run about for me.
The whole experience has been wonderful. The bilateral procedure is a big demand on your body, there’s no good leg and you have to take recovery slowly but I talked it through at length with Professor Wilson and felt sure I could cope with it. I think I have done remarkably well. I don’t have
the words to express to Professor Wilson how grateful I am to him. I have waited a long time for this, It will truly be life changing for me.



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