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Orthopaedics · UK

Osteotomy - realign the bone, keep the joint.

Precision bone-cutting surgery that shifts load off the worn side of a joint - high tibial and distal femoral osteotomy for knee arthritis, periacetabular osteotomy for hip dysplasia, and bunion correction. A high-volume consultant surgeon, 3D planning, and an honest comparison with replacement first.

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

Indicative pricing

What private osteotomy surgery costs in the UK.

Indicative ranges across our partner orthopaedic units.

In short

£8,000–£13,000, home in 1–2 nights.

Procedure Indicative range
High tibial osteotomy (HTO, opening-wedge) £8,000–£13,000
Distal femoral osteotomy (DFO) £8,500–£13,000
Periacetabular osteotomy (PAO) for hip dysplasia £12,000–£20,000
First-metatarsal (bunion) osteotomy £4,500–£7,500
Plate removal (later, if needed) £2,500–£4,500
Standing long-leg alignment X-rays / CT planning £150–£500
Orthopaedic consultation only £200–£350

Prices vary by hospital, by the consultant, by the bone being corrected, and by whether cartilage or ligament surgery is combined at the same sitting. Patient-specific 3D-printed guides and PAO are always the top of the range.

The problem

Too many active fifty-year-olds are offered a replacement - or nothing.

Osteotomy sits in a gap: too specialised for the general knee clinic, too unfamiliar for many GPs to raise. Patients who would be ideal candidates are never told it exists.

  • Is your own joint worth keeping?

    If the wear is on one side only and the leg is malaligned, realignment can relieve pain for a decade while keeping every future option open.

  • Planning is everything

    A correction that is two degrees off blunts the benefit. Standing long-leg X-rays, CT planning and a high-volume surgeon are non-negotiable - and we insist on them.

  • Plan the six weeks on crutches before you consent

    Protected weight-bearing shapes work, driving and family life. We help you map it out before surgery, not discover it after.

When it helps

When osteotomy is the right step.

The situations we see most, plus the one red flag that means emergency assessment rather than a routine appointment.

  • Medial knee arthritis in an active patient

    Wear confined to the inner (medial) compartment with a bow-legged (varus) alignment - the classic HTO case, typically under 60 and keen to stay active.

  • Lateral compartment wear with knock-knee

    Valgus malalignment overloading the outer compartment - corrected with a distal femoral osteotomy rather than a tibial one.

  • Too young for a knee replacement

    Replacements in the under-55s wear out and face revision. Osteotomy preserves your own joint and typically buys 8–10+ years before any replacement is needed.

  • Malalignment after fracture or injury

    A tibia or femur that healed at the wrong angle after a break, overloading one side of the knee or ankle - realignment corrects the mechanics.

  • Protecting a cartilage or meniscal repair

    Cartilage grafts and meniscal transplants fail in a malaligned knee. Osteotomy offloads the repair so it can survive.

  • Hip dysplasia in a young adult

    A shallow hip socket causing pain and early wear - a periacetabular osteotomy (PAO) reorients the socket and can defer hip replacement by decades.

  • Painful bunion deformity

    A first-metatarsal osteotomy (scarf/Akin and similar) realigns the big toe when a bunion causes pain, footwear problems or crossing toes.

  • Red flag: hot, swollen joint with fever

    A rapidly painful, hot, swollen joint with fever may be septic arthritis - an emergency needing same-day hospital assessment, not an osteotomy work-up.

Procedure options

Which bone, which cut - it depends on the deformity.

What each option involves - from the standard opening-wedge knee osteotomy through hip periacetabular surgery to bunion correction, and where 3D planning fits in.

  • Medial opening-wedge HTO

    The workhorse knee osteotomy in the UK. The tibia is cut below the joint, opened on the inner side to the planned angle and fixed with a plate - shifting load off the worn medial compartment.

  • Lateral closing-wedge HTO

    An alternative technique removing a wedge of bone laterally. Less common now, but preferred by some surgeons and in some anatomies.

  • Distal femoral osteotomy (DFO)

    For valgus (knock-knee) malalignment overloading the lateral compartment - the femur is cut and realigned just above the knee.

  • Double-level osteotomy

    When the deformity sits in both femur and tibia, correcting one bone alone would create an oblique joint line - both are corrected in one sitting.

  • Periacetabular osteotomy (PAO)

    For hip dysplasia in adolescents and young adults. The socket is cut free and reoriented over the femoral head - specialist surgery in a handful of UK centres.

  • First-metatarsal (bunion) osteotomy

    Scarf, Akin, chevron and minimally invasive variants realign the big toe. Day-case, walking in a stiff-soled shoe from day one.

  • Osteotomy with cartilage surgery

    Combined with cartilage repair, meniscal transplant or ACL reconstruction where realignment is needed to protect the reconstruction.

  • Patient-specific 3D-planned osteotomy

    CT-based planning with 3D-printed cutting guides - increasingly standard, improving the accuracy of the correction to within a degree or two.

Safety and recovery

What to expect afterwards - honestly.

Osteotomy is well-established surgery with excellent results in the right patient. The things worth planning are the accuracy of the correction, the six weeks on crutches, and bone healing.

  • General or spinal anaesthetic, in a proper theatre

    HTO, DFO and PAO are done under general or spinal anaesthetic with a 1–2 night stay (longer for PAO). Bunion osteotomy is usually a day-case.

  • Six weeks on crutches - plan for it

    Protected weight-bearing on crutches for around 6 weeks is standard for knee osteotomy while the bone heals. Work, driving and childcare need arranging in advance.

  • Delayed union or non-union

    The cut bone occasionally heals slowly or not at all - a few percent of cases, higher in smokers. Stopping smoking before surgery is the single biggest thing you can do.

  • Infection, DVT and PE

    Deep infection is uncommon (around 1–2 percent); DVT prophylaxis is routine. Call the same day for fever, a hot swollen calf or breathlessness.

  • Nerve irritation and numbness

    A patch of numbness near the scar is common and usually fades. Injury to larger nerves is rare but recognised, particularly in lateral closing-wedge and foot surgery.

  • Under- or over-correction

    The benefit depends on hitting the planned angle. This is why alignment imaging, careful planning and an experienced surgeon matter more here than in almost any other orthopaedic operation.

  • The plate can be felt - and removed

    Some patients feel the plate under the skin. If it niggles, it can be removed as a day-case once the bone has fully healed, usually after 12–18 months.

  • It buys time; it is not forever

    A well-done HTO typically gives 8–10+ years of good function. Many patients eventually need a knee replacement - which remains perfectly possible after osteotomy.

  • Red flags after surgery

    Fever, spreading redness, wound discharge, a sudden inability to bear weight after doing so, calf pain or breathlessness need the same-day team or A&E, not a routine call.

Reading your operation note

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

Whichever bone was corrected - tibia, femur, pelvis or metatarsal - the note the surgeon sends you keeps to the same shape.

A UK consultant orthopaedic surgeon reviewing a patient’s alignment 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 operation note and the weight-bearing plan before your review, just ask.

  1. 01 Header

    Indication, side and osteotomy type

    Why the operation was done, which bone was cut (tibia, femur, pelvis, metatarsal), the technique (opening or closing wedge) and the planned correction angle.

  2. 02 Technique

    Cut, correction and fixation

    How the osteotomy was performed - guides used, the wedge opened or closed, whether bone graft was placed, and the plate and screws used to fix it.

  3. 03 Findings

    Joint surfaces and achieved correction

    The state of the cartilage seen at surgery (if arthroscopy was combined), the correction achieved on the table, and any additional procedures performed.

  4. 04 Impression

    Weight-bearing plan and follow-up

    Read this first: exactly how much weight you may put through the leg and when, the physio milestones, and the X-ray schedule that gates each step up.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Osteotomy is usually covered when medically indicated - arthritis, malalignment, dysplasia or a symptomatic bunion all qualify with consultant confirmation.

Frequently asked

Everything we get asked about osteotomy.

Quick answers on osteotomy versus replacement, how long it lasts, recovery, cost and NHS availability.

  • What actually happens in a knee osteotomy?

    The surgeon cuts the tibia (HTO) or femur (DFO) near the knee and opens or closes a precisely planned wedge, changing the leg’s alignment by a few degrees. That small change shifts your body weight off the worn compartment and onto the healthy one. The bone is fixed with a plate and screws and heals in its new position over about six weeks.

  • Osteotomy or knee replacement - how do I choose?

    Osteotomy suits younger, active patients (typically under 60) with wear confined to one compartment and a correctable malalignment - it keeps your own joint and places no restriction on impact activity once healed. Replacement suits older patients or wear across the whole joint. A partial (unicompartmental) replacement sits between the two.

  • How long will an osteotomy last?

    A well-planned HTO typically gives 8–10 years or more of good function before any further surgery, and many patients go well beyond that. Survivorship depends heavily on the accuracy of the correction - another reason surgeon volume and 3D planning matter. If a knee replacement is eventually needed, prior osteotomy does not prevent it.

  • What is recovery really like?

    Expect 1–2 nights in hospital, then around 6 weeks of protected weight-bearing on crutches while the bone heals, with X-rays before you are cleared to load fully. Office work is realistic from 2–4 weeks, driving usually once you are off crutches and can perform an emergency stop, gym work from about 3 months, and return to running and impact sport at 6–9 months.

  • What is a periacetabular osteotomy (PAO)?

    PAO treats hip dysplasia - a socket too shallow to cover the femoral head - in adolescents and young adults. The pelvis is cut around the socket, which is reoriented to cover the head properly and fixed with screws. It is bigger surgery than knee osteotomy, done in a small number of specialist UK centres, and can defer hip replacement by decades in the right patient.

  • How much does private osteotomy surgery cost in the UK?

    Roughly £8,000–£13,000 for a high tibial or distal femoral osteotomy, £12,000–£20,000 for a periacetabular osteotomy, and £4,500–£7,500 for a bunion (first-metatarsal) osteotomy. Consultations run £200–£350 and alignment X-rays or CT planning £150–£500.

  • Is osteotomy available on the NHS?

    Yes - knee osteotomy, PAO and bunion surgery are all established NHS operations. Availability varies considerably by region, because osteotomy is concentrated in units with a specialist interest, and waits for planning imaging plus surgery can be long. Going privately mainly buys choice of a high-volume surgeon and a faster, joined-up pathway.

  • Will insurance cover it?

    Usually, yes - osteotomy for arthritis, malalignment, dysplasia or a symptomatic bunion is treatment of a medical condition, and Bupa, AXA, Vitality, Aviva and the other major insurers cover it when a consultant confirms the indication.

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