Concierge orthopaedics · London
High tibial osteotomy in London, to keep your own knee for another decade.
A joint-preserving realignment of the shinbone for active adults with medial-side knee wear. A consultant knee surgeon, proper planning, and every alternative on the table first.
Why patients choose us
- 01
A consultant knee surgeon, not a generalist
A named BASK-affiliated knee surgeon who does osteotomies weekly — not a hip-and-knee generalist who does a handful a year.
- 02
Every alternative on the table first
Unloader brace, weight loss, injections, genicular artery embolisation, UKA — we lay them out honestly before you commit to a saw cut.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private HTO costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three surgeons.
In short
A standard medial opening wedge HTO in our network: £9,500–£13,500, home in one to two nights.
| Procedure | Indicative range | Typical duration | Hospital stay |
|---|---|---|---|
| Medial opening wedge HTO (MOWHTO) | £9,500–£13,500 | 60–90 min | 1–2 nights |
| Distal femoral osteotomy (DFO) | £10,000–£14,000 | 75–100 min | 1–2 nights |
| Double-level osteotomy (HTO + DFO) | £13,500–£18,000 | 2–3 hours | 2–3 nights |
| Osteotomy with PSI 3D-printed guides | £11,500–£15,500 | 60–90 min | 1–2 nights |
| Hardware removal (at 12–18 months) | £2,500–£4,500 | 30–45 min | Day case |
| Consultation and full-length X-rays | £300–£550 | 45 min | Same visit |
Prices vary by hospital, by which knee surgeon does the case, by the implant chosen, and by whether 3D-printed cutting guides or extra cartilage work are added. We come back with a firm quote within one working day.
The problem
Too young for a knee replacement, too worn to keep running.
The classic HTO patient is 40–60, still active, and being told to lose weight and come back in ten years for a joint replacement. There is a middle option — done properly, it works.
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Told you are too young for a TKR?
An HTO keeps your native knee and buys 10–15 years for many patients. It is exactly what the middle ground is for.
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Not sure between HTO and UKA?
A consultant knee surgeon should show you the alignment X-rays and explain why one fits your knee and lifestyle better than the other.
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Want your sport back?
HTO patients cycle at three months and run at six to nine. The plan is designed around that goal, not just pain relief.
The journey
From enquiry to back on the bike — what happens, in order.
One clinician from first message to nine-month review — including the rehab window.
Phase 1 · Before surgery
Concierge, off-stage for you
Phase 2 · Admission
One to two nights in hospital
Phase 3 · Rehab
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Where the knee hurts, what you have already tried, and what you want to keep doing — sport, work, family.
- 02
Before
We come back with a recommendation
Within one working day: whether an HTO fits, whether a DFO or UKA is a better call, and an indicative price across two or three surgeons.
- 03
Before
Imaging and planning
Full-length standing X-rays for the mechanical axis, an MRI for the compartments and ligaments, and often a CT for 3D planning or a patient-specific cutting guide.
- 04
Admission
Arrival at the hospital
Admission, consent and a chat with the surgeon and anaesthetist. Regional block plus GA is the usual pick.
- 05
Admission
The osteotomy itself
60 to 90 minutes in theatre. A medial opening wedge, guided by the plan, held with a locking plate and screws — occasionally with bone substitute.
- 06
Admission
One or two nights in
Physio starts the same day — knee bend, quad activation, crutches. Home the next day, or the day after, in a brace or boot.
- 07
After
Rehab and review
Partial weight-bearing for six weeks, gradual loading, physio all the way. Back to office work in two to four weeks; cycling by three months; running six to nine.
Typical end-to-end: 3–6 weeks from enquiry to surgery. Full return to running: 6–9 months.
When it helps
When a high tibial osteotomy is the right step.
The situations we see most, plus a note on when an HTO is not the right operation and something else fits better.
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Medial compartment knee OA
Wear localised to the inner half of the knee, usually with a varus (bow-legged) mechanical axis on standing X-ray.
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Varus malalignment in a young knee
Mechanical axis passing medial to the knee centre in a patient under 55–65, active, and not ready for a joint replacement.
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Post-meniscectomy medial overload
Pain after a previous medial meniscectomy where the compartment is overloaded but not yet arthritic.
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AVN of the medial femoral condyle
Spontaneous osteonecrosis of the knee on the medial side — unloading with an osteotomy can rescue the joint.
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Ligament reconstruction with malalignment
Combined ACL or PLC reconstruction in a knee that also needs its axis corrected — a slope-changing HTO helps both.
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Valgus knee with lateral OA
The mirror problem — usually treated with a distal femoral osteotomy rather than an HTO.
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Combined varus and valgus deformity
Deformity split across the tibia and femur — sometimes needs a double-level osteotomy to get the axis right.
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Red flag: HTO is not for everyone
Tri-compartmental OA, significant patellofemoral disease, a flexion contracture over 10°, or BMI well over 35 usually push the decision towards a knee replacement.
Procedure options
An HTO is not the only option.
The realignment procedures in modern use — and the non-surgical alternatives worth trying first.
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Medial opening wedge HTO
The workhorse UK operation. The medial tibia is cut, opened to the planned angle, and held with a locking plate — bone substitute added if the gap is large.
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Lateral closing wedge HTO
The older technique — a wedge is taken from the lateral tibia and a fibular osteotomy is added. Less popular now with modern plates.
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Distal femoral osteotomy (DFO)
The mirror procedure — the femur is cut just above the knee to unload a worn lateral compartment in a valgus knee.
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Double-level osteotomy
HTO plus DFO in one setting for combined deformities — used sparingly and always with 3D planning.
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Osteotomy with PSI cutting guides
A 3D-printed patient-specific instrument based on your CT — the wedge angle is preset, the hinge is planned, and the operation is faster and more reproducible.
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Bone-graft-free HTO
Modern locking plates (TomoFix, PEEKPower) hold the correction without needing allograft or synthetic bone in most small-to-medium wedges.
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Combined HTO with cartilage or ACL work
A single trip to theatre for the osteotomy plus a cartilage procedure, meniscal work, or an ACL reconstruction.
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Consultation only
An honest discussion of whether an osteotomy, a UKA, or a non-surgical route fits best — no obligation.
Our vetted London network
A small panel of knee surgeons, we picked them.
BASK-affiliated consultants across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your knee.
Selection criteria
How we choose every knee surgeon in our network.
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BASK-affiliated consultant knee surgeons doing osteotomies weekly
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Full-length standing X-rays and dedicated osteotomy planning software as standard
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PSI 3D-printed cutting guides available where the case warrants it
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Enhanced recovery with day-one physio and a clear rehab plan up to nine months
Safety and recovery
What to expect afterwards — honestly.
HTO is a big operation but a well-worked-out one. The things worth planning are your rehab, your weight-bearing timeline, and knowing what a normal recovery actually looks like.
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Six weeks of partial weight-bearing
Touch-toe on crutches for the first four to six weeks, then gradual loading. Rushing this is the commonest cause of hardware pain later.
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Physio starts on day one
Knee bend, quad activation and crutch work begin the same day as surgery — the plate is designed to allow it.
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Non-union is uncommon but real
Around 2–5% of osteotomies fail to unite fully. Smoking, poorly controlled diabetes and skipped rehab are the main drivers.
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Hinge fracture — usually harmless
A crack in the far cortex during the cut happens in a minority of cases and is almost always managed by the plate without changing recovery.
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DVT prophylaxis is routine
Low molecular weight heparin for two to six weeks and early mobilisation keep clot risk low.
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Hardware pain in 20–30%
The plate sits under thin skin on the medial tibia — a fifth to a third of patients ask for it out once the bone has united at 12–18 months.
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Over- or under-correction
Planning aims to shift the mechanical axis to a specific target. Too little and pain returns; too much and the lateral compartment complains — hence the planning software.
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HTO delays, does not prevent, replacement
A good HTO buys 10–15 years for many patients. A future conversion to a UKA or TKA remains straightforward if it is ever needed.
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Red flags
Fever, spreading redness, calf swelling or sudden loss of correction are not normal — call the team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and planned correction
Why the osteotomy was done — medial OA, malalignment, post-meniscectomy overload — and the target mechanical axis chosen from the plan.
- 02 Technique
Approach, cut and fixation
Medial opening wedge or lateral closing, the wedge angle, whether a hinge fracture occurred, and the plate and screws used.
- 03 Findings
Intra-articular findings and extras
Any cartilage work, meniscal repair, ACL reconstruction, or bone substitute used to fill the wedge.
- 04 Impression
Weight-bearing, brace and rehab plan
Read this first: how long on crutches, brace protocol, physio milestones, and when to return to driving, cycling and running.
Recognised by major UK insurers
Cover for HTO varies by insurer and by indication — usually funded when medially wear and malalignment are clearly documented. We confirm cover before booking.
Frequently asked
Everything we get asked about high tibial osteotomy.
Quick answers on suitability, HTO versus knee replacement, cost, recovery and long-term outcomes.
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What is a high tibial osteotomy and who is it for?
An HTO is a joint-preserving operation that re-cuts the top of the shinbone to shift the load away from a worn part of the knee. It suits active patients — usually under 55–65 — with wear localised to one compartment (most often the inner half), a bow-legged alignment on standing X-ray, an intact or reconstructable ACL, and a knee that still bends well.
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HTO or knee replacement — how do I choose?
A UKA or TKA replaces the joint surfaces; an HTO keeps your native knee and buys time. HTO wins for younger, active patients with single-compartment wear and malalignment. UKA/TKA wins for older, lower-demand patients or when wear is widespread. A consultant knee surgeon should walk you through both — we make sure that happens.
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How long does an HTO last?
Ten-year survival before conversion to a knee replacement is around 75–85% in modern series, and 80–90% of patients report clear improvement at five years. Outcomes depend heavily on patient selection, alignment target and BMI.
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How much does a private HTO cost in London?
Roughly £9,500–£13,500 for a standard medial opening wedge HTO, £10,000–£14,000 for a distal femoral osteotomy, and £13,500–£18,000 for a double-level. PSI 3D-printed guides add £1,000–£2,000. Hardware removal at 12–18 months is £2,500–£4,500 if needed.
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What is the recovery timeline?
Partial weight-bearing on crutches for four to six weeks, gradual loading to six to twelve weeks, physio throughout. Office work in two to four weeks, driving at six to eight, cycling at two to three months, running at six to nine months, and contact sport at nine to twelve.
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Do I need the plate taken out later?
Around 20–30% of patients ask for hardware removal once the bone has united at 12–18 months — usually because the plate is irritating under the thin skin on the medial tibia. It is a straightforward day-case procedure.
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What are the main risks?
Non-union in 2–5%, hinge fracture (usually clinically silent with modern plates), infection in 2–5%, DVT/PE (mitigated with heparin), stiffness, hardware pain, tibial plateau fracture, and — rarely with medial opening — peroneal nerve injury. Under- or over-correction remains the alignment-specific risk.
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Are there non-surgical alternatives worth trying first?
Yes — weight loss, targeted physiotherapy, an unloader brace, hyaluronic acid or PRP injections, and in selected cases genicular artery embolisation. They will not correct malalignment, but they can buy time and are always discussed first.
Related treatments
Looking for something else?
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