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Joint-preservation knee surgery · UK

Private knee realignment surgery, by a consultant knee-preservation surgeon.

An osteotomy - HTO, DFO, double-level or TTO - that shifts weight away from the worn compartment of your knee. Planned in 3D, done in theatre by a BASK-affiliated surgeon, and only recommended if you are genuinely the right patient.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private knee osteotomy costs in the UK.

Indicative ranges across UK private providers.

In short

£8,000–£12,000, one night in hospital.

Procedure Indicative range
Medial opening wedge HTO (single-level) £8,000–£12,000
Distal femoral osteotomy (DFO) £9,000–£13,000
Double-level osteotomy (HTO + DFO) £13,000–£16,000
Tibial tubercle osteotomy (TTO/Fulkerson) £7,500–£11,000
PSI (3D-printed cutting guide) supplement £1,200–£2,500
Consultation with imaging review £250–£450

Prices vary by clinic, by the surgeon, by whether PSI 3D-printed guides are used, by implant choice, and by any concurrent procedures (ligament reconstruction, meniscal work, cartilage repair).

The problem

The right patient, the right osteotomy, the right correction.

A knee osteotomy is a superb operation in the right patient and a mediocre one in the wrong. We spend the front-end of the case making absolutely sure which you are.

  • Too young for a replacement?

    A native knee, kept sporting for another decade or more, is worth the recovery. If you fit the profile, an osteotomy is the right conversation.

  • Told it is bone-on-bone?

    Isolated to one compartment, with a correctable malalignment and preserved cartilage elsewhere, is still an osteotomy case - not automatically a replacement.

  • Been offered UKA or TKR?

    A second opinion from a knee-preservation surgeon is worth having before you accept an implant.

When it helps

When a knee osteotomy is the right step.

The situations we see most, plus the one red flag that means an emergency rather than a planning conversation.

  • Varus knee, medial-side pain

    A bow-legged knee with wear on the inner compartment - the classic indication for a medial opening wedge HTO.

  • Valgus knee, lateral-side pain

    A knock-kneed knee with wear on the outer compartment - usually corrected with a distal femoral osteotomy.

  • Post-meniscectomy overload

    Compartmental pain years after a meniscectomy, with malalignment tipping load onto the worn side.

  • Patellofemoral pain and maltracking

    Anterior knee pain with a maltracking kneecap - a Fulkerson-style tibial tubercle osteotomy unloads and realigns it.

  • Recurrent patellar dislocation

    A kneecap that keeps popping out, often with trochlear dysplasia - TTO, MPFL reconstruction or trochleoplasty are combined as needed.

  • ACL reconstruction + malalignment

    A ligament reconstruction is more likely to last when the mechanical axis is corrected at the same time.

  • Focal avascular necrosis

    Early-stage AVN of a single compartment can be offloaded by an osteotomy to preserve the joint.

  • Red flag: locked, hot or septic knee

    A knee that is locked, hot, red or draining is not a planning conversation - it is A&E the same day.

Procedure options

One procedure name, several very different operations.

What each type of osteotomy actually involves - and which deformity or symptom it is designed for.

  • Medial opening wedge HTO

    The workhorse for the varus knee with medial compartment OA. A wedge is opened on the inner tibia and held with a locking plate.

  • Lateral closing wedge HTO

    An older technique for varus knees that removes a wedge and needs a fibular osteotomy - largely superseded by the opening wedge.

  • Distal femoral osteotomy (DFO)

    For valgus knees with lateral compartment OA. An opening or closing wedge on the femur, plated. Medial or lateral approach depending on the deformity.

  • Double-level osteotomy (HTO + DFO)

    When a large deformity would tip the joint line if corrected from one bone alone, both are corrected - each contributing a smaller wedge.

  • Tibial tubercle osteotomy (TTO)

    The Fulkerson anteromedialisation for patellofemoral OA and maltracking; medialisation alone for instability.

  • Trochleoplasty

    For high-grade trochlear dysplasia with recurrent patellar instability. Deepens the groove - done only in specialist BASK centres.

  • Rotational osteotomy

    For femoral or tibial torsional deformity contributing to patellofemoral pain - rare, and only after careful CT rotational profiling.

  • Supracondylar femoral osteotomy

    To correct malunion after a previous distal femoral fracture that has healed in the wrong position.

Alternatives to surgery - activity modification, weight loss and physio, HA or PRP injections, an unloader brace, or genicular artery embolisation - are discussed at the same consultation. For advanced or multi-compartment disease, a unicompartmental or total knee replacement may be the honest recommendation instead.

Safety and recovery

What to expect afterwards - honestly.

A knee osteotomy is a bigger operation than most patients expect. The recovery is structured, slow and worth planning for.

  • GA or spinal with sedation

    Most osteotomies are done under GA. A spinal with sedation is an option for patients who would rather not have a full anaesthetic.

  • Partial weight-bearing for 4–6 weeks

    You will be on crutches, touch-weight-bearing, in a hinged brace. This is non-negotiable - the bone needs to heal in the corrected position.

  • Non-union in 2–5%

    The most talked-about complication. Smokers and poorly controlled diabetics are at higher risk - we say so up front.

  • Hardware pain in 20–30%

    The plate sits close to the skin and can be irritating. Removal is a small day-case procedure at 12–18 months if it bothers you.

  • DVT prophylaxis is routine

    Low-molecular-weight heparin for 10–14 days, plus mobilisation from day one, brings clot risk down to background levels.

  • Return to sport is slow

    Cycling by 8–12 weeks. Running by 6–9 months. Contact sport by 9–12 months. Anyone promising faster is misleading you.

  • Over- or under-correction

    Careful planning avoids this, but a small residual mal-alignment can occur - and matters for long-term outcome.

  • Rare but real: nerve, fracture, CRPS

    Peroneal nerve injury (more with lateral closing wedge), tibial plateau fracture and complex regional pain syndrome are uncommon but discussed properly at consent.

  • Osteotomy delays, does not prevent, TKR

    Expect 10–15 years of native-knee use before a replacement is discussed. Conversion to UKA or TKR later is straightforward on a pre-corrected leg.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever osteotomy was performed, the note the surgeon sends you keeps to the same shape.

A UK consultant knee surgeon reviewing long-leg X-rays and operation notes

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.

  1. 01 Header

    Deformity, side and osteotomy chosen

    The measured mechanical axis, the target correction (usually the Fujisawa point for HTO), and the osteotomy performed.

  2. 02 Technique

    Anaesthetic, approach and fixation

    GA or spinal, mini-open incision, cutting guide or PSI used, the wedge size opened, and the plate / screws that held it.

  3. 03 Findings

    Cartilage, meniscus and ligament status

    What the arthroscopic look showed - cartilage grade in each compartment, meniscus condition, and any concurrent procedures.

  4. 04 Impression

    Weight-bearing, brace and physio schedule

    Read this first: the exact weight-bearing plan, brace regime, physio milestones and when the first X-ray review is.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for knee osteotomy varies by insurer and by indication - usually funded when medically indicated for compartmental OA or instability.

Frequently asked

Everything we get asked about knee osteotomy.

Quick answers on cost, recovery, longevity and how it compares with a knee replacement.

  • Who is a good candidate for knee realignment surgery?

    Typically an active patient under 55–65 with pain in one compartment of the knee, a matching mechanical malalignment (varus for medial, valgus for lateral), a good range of movement, an intact or reconstructable ACL, no significant patellofemoral OA, and a BMI ideally under 35. Motivation matters - the recovery is long.

  • How is an osteotomy different from a knee replacement?

    A knee replacement resurfaces the joint with metal and plastic. An osteotomy preserves your own joint by cutting the bone above or below the knee and shifting your weight-bearing axis away from the worn compartment. It is a joint-preserving operation for younger patients - a replacement is the endpoint for older or more advanced disease.

  • How much does knee realignment surgery cost privately in the UK?

    A single-level HTO is typically £8,000–£12,000, a DFO £9,000–£13,000, and a double-level osteotomy £13,000–£16,000. A tibial tubercle osteotomy is £7,500–£11,000. PSI (3D-printed cutting guides) adds £1,200–£2,500.

  • How long is the recovery from an osteotomy?

    Partial weight-bearing on crutches for 4–6 weeks, in a hinged brace for 6 weeks. Office work 2–4 weeks, driving 6–8 weeks, cycling 8–12 weeks, running 6–9 months, contact sport 9–12 months. Full bone healing takes 3–4 months.

  • How long does an osteotomy last before I need a knee replacement?

    In well-selected patients, 10-year survivorship before conversion to arthroplasty is 75–85%, with 80–90% patient-reported improvement at 5 years. It is designed to buy you 10–15 years of native-knee function, not to be permanent.

  • What are the main risks of an osteotomy?

    Non-union of the bone (2–5%), infection (2–5%), DVT (routinely prevented with heparin), hardware irritation needing later removal (20–30%), stiffness, hinge fracture, tibial plateau fracture, over- or under-correction, and - very rarely - peroneal nerve injury or CRPS. Eventual conversion to a knee replacement is expected, not a complication.

  • What is a patient-specific instrumentation (PSI) osteotomy?

    PSI uses a CT scan to design a 3D-printed cutting guide that fits your specific bone. It makes the cut and the wedge more accurate than freehand jigs, which matters most for double-level and complex corrections. Increasingly used in UK BASK centres.

  • Can I still have a knee replacement later if the osteotomy fails?

    Yes - and typically it is easier, because the leg has been realigned. Both unicompartmental (UKA) and total knee replacement (TKR) can be done afterwards, and modern implants are designed with prior osteotomies in mind.

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