Treatment
Most knee operations for arthritis replace the worn surface. A knee osteotomy does something entirely different: it changes the angle of your leg so that your body weight stops travelling through the worn side of the joint and starts travelling through the side that is still healthy. Nothing inside the knee is replaced. You keep your own joint, your own cartilage and — unusually for arthritis surgery — permission to run, kneel and work. For the right patient, it buys a decade or more before a replacement is even a conversation.
Make an appointment: (65) 8096 4668 · WhatsApp · ssoc_enq@bone.com.sg
Think of a bow-legged knee as a building settling onto one corner of its foundation. The cartilage on the inner side takes far more than its share of every step, so that is where it wears out first — and every step afterwards makes it worse. An osteotomy corrects the geometry: a precise cut is made in the shin bone just below the knee (or in the thigh bone above it, for knock-kneed wear), the alignment is opened or closed by a planned number of degrees, and a plate holds the correction while the bone heals solid. The arthritis is not removed. It is simply taken out of the load path — and cartilage that stops being crushed frequently stops hurting.
How your weight is shared between the two sides
Figures reflect published series for well-selected patients — our specialist will discuss what your own alignment, wear pattern and goals make realistic.
People offered an osteotomy usually arrive with one dominant question. Tap yours — the straight answer is one scroll away.
In well-chosen knees, yes — and the mechanism is refreshingly simple to understand. Pain in single-sided arthritis comes largely from an overloaded compartment: cartilage compressed beyond what it can tolerate, bone beneath it irritated by the pressure. Take a substantial share of that load away and the tissue gets relief it cannot get any other way — no injection, no exercise programme and no brace shifts weight the way changing the angle of the bone does. What honest expectation looks like: most patients get major, durable improvement rather than a knee that feels twenty again, and the joint still has arthritis in it — it is simply no longer being crushed. Selection is what separates good results from disappointing ones, which is why the candidacy section below matters more on this page than on most.
A fair question, and the risks are specific to bone healing rather than to the joint. The most relevant one: the bone healing slowly or incompletely, which is uncommon in healthy patients but far more likely in smokers — smoking is not a lifestyle footnote here, it is the single biggest modifiable threat to the operation’s success, and we will ask you to stop. The uncommon: infection, blood clots in the leg, and the correction ending up slightly under or over what was planned, which careful pre-operative measurement is designed to prevent. The predictable and manageable: the plate becoming noticeable or irritating over time — a proportion of patients later have it removed in a small day procedure once the bone is solid. Nerve irritation near the outer shin is uncommon and usually temporary. All of this is weighed against the alternative: continuing to grind down a compartment you cannot get back.
Be prepared for this one honestly: the early recovery is slower than a knee replacement’s. Bone healing sets the pace and cannot be hurried. Expect crutches with protected weight-bearing for roughly six weeks, most of the healing complete around three months, and a return to sport or heavy work somewhere between six and twelve months. Knee movement, though, starts immediately — stiffness is the enemy from day one. The trade you are making is a harder first three months in exchange for a joint you keep and activities you don’t have to give up. Wherever you are:
This decision is made on standing X-rays, not on how the knee feels. Full-length alignment films show exactly where your weight travels and whether the wear is genuinely confined to one side. That assessment tells you whether osteotomy, replacement or continued conservative care fits — and you’ll get the reasoning, not just the recommendation.
Two preparations matter more here than for most operations. If you smoke, stopping is not advice — it is part of the treatment, because bone healing depends on it. And arrange your life for six weeks on crutches: a home that works without stairs where possible, help with shopping, and time booked off honestly rather than optimistically.
Respect the weight-bearing limits — they are protecting a healing bone. Move the knee daily from the start, keep the thigh muscle working, and follow the X-ray reviews that confirm the bone is knitting. Report calf pain, fevers or a sudden change in the knee promptly. The heavy things return when the films say so.
Partly — and that is the point, not a criticism. An osteotomy does not cure arthritis; it unloads it. The joint carries on ageing, and for some patients a replacement eventually follows. But look at what the delay is worth. Knee implants have a finite lifespan, so a replacement at forty-five is likely to need revising — a bigger, less predictable operation — whereas a replacement at sixty may comfortably last the rest of a life. Meanwhile the osteotomy years are not spent waiting: they are spent running, working, kneeling and playing on your own knee, without the activity restrictions that follow a replacement. And if conversion is ever needed, replacing a previously realigned knee is a well-established procedure. Framed properly, the question isn’t “why delay?” — it’s “which decade would you rather spend on an implant?”
This operation is selective, and honest selection is what makes its results good. It rewards a specific profile — check yours:
That profile is exactly what osteotomy was designed for. The next step is standing alignment X-rays and a consultation that measures the correction your leg would need — then weighs it honestly against partial replacement and against carrying on as you are.
Osteotomy may not be your operation — and that is useful to know early. Arthritis spread across the knee, a stiff joint or lower activity demands usually point toward resurfacing options or continued conservative care instead. An assessment identifies which, with the reasoning laid out.
And remember: the right operation is the one your alignment and your life argue for — including none at all.
Tap the one that sounds like you — and get the straight answer:
A knee osteotomy is realignment surgery. Rather than resurfacing the joint, the surgeon makes a precise cut in the shin bone or thigh bone, adjusts the angle of the leg by a planned amount, and holds it there with a plate and screws while the bone heals in its new position. The purpose is mechanical: shifting body weight off the worn side of the knee and onto the side that still has healthy cartilage.
The classic candidate is younger than about sixty, active, with arthritis confined to one side of the knee and leg alignment that matches it — bow-legged with inner-side wear, or knock-kneed with outer-side wear. A stable knee with good movement helps, as does being a non-smoker, because smoking substantially impairs bone healing. Widespread arthritis, significant stiffness or inflammatory joint disease point toward other options.
Longer than a knee replacement in the early phase, because bone has to heal. Expect protected weight-bearing on crutches for around six weeks, most bone healing over about three months, and a return to sport or physical work between six and twelve months. Movement exercises start immediately — stiffness is the enemy — and the plate is only removed later if it causes irritation.
They suit different people. Osteotomy preserves your own joint, permits running, kneeling and heavy work afterwards, and leaves replacement fully available later — which makes it attractive for younger, active patients with single-sided wear. Replacement gives faster, more predictable pain relief and suits older patients or knees with more widespread arthritis, but implants have a finite lifespan and limit high-impact activity. Age, activity and the pattern of wear decide.
Most well-selected osteotomies are still doing their job a decade later, and many considerably longer. It buys time rather than granting permanence: the arthritis is not removed, only unloaded, so the knee continues to age. If it eventually wears out, converting to a knee replacement remains a well-established operation — which is why an osteotomy is often described as spending your forties and fifties on your own knee.
Related: Knee osteoarthritis · Partial knee replacement · Total knee replacement · Knee surgery
Same-day appointments are usually available. Call or book online — our team will take it from there.
