Osteotomy — High Tibial Osteotomy / Distal Femoral Osteotomy (HTO/DFO)

University of Virginia Orthopaedic Surgery

Weight-Bearing

25% WB weeks 0-4; medial opening wedge HTO: 50% WB weeks 4-6, WBAT weeks 6-8; FWB without crutches by Phase 3 (8+ weeks)

Key Restrictions

No active hamstring exercises first 2 weeks; brace 0-90° then full ROM; caution with CKC knee flexion >90° early; mini-squats limited to 0-45° at weeks 8-10; brace discontinued at 6 weeks if SLR without extensor lag; cardiovascular conditioning (elliptical/swimming) from 12+ weeks only

Timeline & Phases

Phase 1 (0-4 wks): TTWB to 25% WB, brace 0-90° then open, quad NMES, no active HS first 2 wks, SLR, cycling for ROM (wk 2); Phase 2 (4-8 wks): progressive WB (50% wks 4-6, WBAT wks 6-8), discontinue brace at 6 wks, CKC (mini-squats/wall sits/TKE), OKC HS wk 6+, OKC quad ext wk 7+; Phase 3 (8-16 wks): FWB, mini-squats 0-45° wks 8-10, heel taps/step-ups 6-8" wks 10-12, OKC quad full ROM wks 12-14, cardiovascular from wk 12; Phase 4 (3+ months): running progression, plyometrics and agility month 4+

Notes

No active hamstring exercises for first 2 weeks; WB progression listed for medial opening wedge HTO specifically; mini-squats limited to 0-45° at weeks 8-10; cardiovascular conditioning (elliptical/swimming) from 12+ weeks; plyometrics and agility begin month 4; covers both HTO and DFO

Published

12/2024