Osteotomy — High Tibial Osteotomy (HTO) / Femoral Osteotomy

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

NWB with brace locked in extension x 6 wks; WBAT wk 7 with 2 crutches; D/C crutches when no extension lag, full extension, non-antalgic gait; D/C brace at 8 wks

Key Restrictions

NWB x 6 wks; brace locked in extension for all activities except therapeutic exercises/CPM x 4 wks; brace unlocked for ambulation at 6 wks; D/C brace at 8 wks with physician approval; no CKC x 6 wks; CPM 0-45° increasing 15°/wk to 90° goal; if HTO combined with ACL reconstruction, use HTO protocol; PT 3-6 months supervised

Timeline & Phases

Phase I (0-4 wks): NWB, brace locked in extension, CPM 8 hrs/day 0-45° increasing 15°/wk to 90°, ankle pumps, quad sets, patellar mobilizations, SLR, HS/calf stretching | Phase II (4-6 wks): continue NWB, progress toward full flexion, D/C CPM if ≥90° flexion, aquatic therapy, stationary bike low resistance | Phase III (6-8 wks): WBAT at wk 7, brace unlocked at 6 wks/D/C at 8 wks, mini-squats 0-45° progressing to step-ups, 4-way hip, stationary bike with resistance, leg press 0-60°, CKC TKE, toe raises, balance/KAT, HS curls | Phase IV (3-9 months): CKC progression, treadmill walking, swimming, pool jogging with wet vest, sports-specific or work hardening

Notes

Protocol identical for femoral or tibial osteotomy; if combined with ACL reconstruction, use HTO protocol; CPM starts 0-45° increasing 15°/wk to 90°; driving 1 wk post-op for automatic car left-leg surgery, 6 wks for standard car or right-leg surgery; D/C brace at 8 wks with physician clearance; supervised PT 3-6 months; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD