Stylized knee joint illustration symbolizing bone healing after osteotomy.

Unlocking Knee Health: How to Avoid Healing Delays After Tibial Osteotomy

Avery Sinclair in Health & Wellness November 2025 • 4 min read.

"Expert insights on open-wedge high tibial osteotomy (OWHTO) to ensure optimal bone formation and recovery."

Open-wedge high tibial osteotomy (OWHTO) is a surgical procedure aimed at correcting knee alignment, particularly in cases of osteoarthritis. The goal is to shift weight away from the damaged area of the knee, relieving pain and improving function. While OWHTO has a high success rate, complications such as delayed bone healing can occur, prolonging recovery and potentially impacting long-term outcomes.

A recent study published in Knee Surgery, Sports Traumatology, Arthroscopy sheds light on the factors that contribute to delayed bone healing after OWHTO. By understanding these risk factors, patients and surgeons can work together to optimize the healing process and minimize potential setbacks.

This article synthesizes the findings of this research, providing accessible insights and actionable advice for anyone considering or recovering from OWHTO. We will discuss the critical elements that influence bone formation, offering a comprehensive guide to a smoother, faster recovery.

Understanding Bone Formation After OWHTO

Stylized knee joint illustration symbolizing bone healing after osteotomy.

The study, led by Kenichi Goshima and colleagues, evaluated bone formation in 102 knees (93 patients) that underwent OWHTO without bone grafting. Researchers meticulously tracked bone formation within the osteotomy gap—the space created during surgery—using X-rays and computed tomography (CT) scans. The osteotomy gap was divided into distinct zones to assess the progression of bone healing from the lateral (outer) hinge towards the medial (inner) side of the knee.

The study defined gap filling as the zone in which trabecular bone continuity could be observed on anteroposterior radiographs. The researchers evaluated bone formation in the osteotomy gap at 3, 6, and 12 months postoperatively; at plate removal; and at the final follow-up (mean, 62.3±30.2 months).

The key findings of the study highlighted several critical factors:

Progression of Healing: Bone formation typically progresses from the lateral hinge towards the medial side of the osteotomy gap.
Importance of Plate Removal: Gap filling progresses even further after plate removal, without compromising the corrected knee alignment.
Risk Factors: Three primary factors were identified as significantly delaying bone formation: large opening gaps, unstable hinge fractures, and osteotomy line placement below the safe zone.

These findings emphasize the importance of surgical technique and postoperative care in ensuring successful bone healing. Let's delve deeper into the specific risk factors identified in the study.

Ensuring Optimal Healing: A Collaborative Approach

Successful recovery after OWHTO requires a collaborative effort between the patient and their surgical team. By understanding the risk factors for delayed bone healing and adhering to postoperative guidelines, patients can significantly improve their chances of a smooth and timely recovery. Remember to openly communicate any concerns with your healthcare provider and actively participate in your rehabilitation program. Staying informed and proactive is the best way to unlock lasting knee health and get back to the activities you love.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00167-018-5334-3, Alternate LINK

Title: Large Opening Gaps, Unstable Hinge Fractures, And Osteotomy Line Below The Safe Zone Cause Delayed Bone Healing After Open-Wedge High Tibial Osteotomy

Subject: Orthopedics and Sports Medicine

Journal: Knee Surgery, Sports Traumatology, Arthroscopy

Publisher: Springer Science and Business Media LLC

Authors: Kenichi Goshima, Takeshi Sawaguchi, Kenji Shigemoto, Shintaro Iwai, Akira Nakanishi, Daisuke Inoue, Yosuke Shima

Published: 2018-12-11

Everything You Need To Know

What is the purpose of undergoing an open-wedge high tibial osteotomy (OWHTO), and what are the potential complications related to bone healing?

Open-wedge high tibial osteotomy (OWHTO) is performed to correct knee alignment, particularly when osteoarthritis is present. It aims to redistribute weight away from the damaged part of the knee, which reduces pain and improves overall function. While OWHTO generally has a good success rate, complications such as delayed bone healing can occur, leading to prolonged recovery times and potentially affecting long-term results. Factors influencing bone healing, like the size of the opening gap created during surgery, the stability of the hinge fracture, and the precise placement of the osteotomy line, are crucial considerations for successful outcomes.

According to the study, what are the primary risk factors that can delay bone formation following an open-wedge high tibial osteotomy (OWHTO)?

The study by Kenichi Goshima and colleagues identified three main risk factors that contribute to delayed bone formation after open-wedge high tibial osteotomy (OWHTO). These include large opening gaps created during the procedure, unstable hinge fractures which compromise stability, and osteotomy line placement below the safe zone, impacting the healing process. Addressing these factors through careful surgical technique and postoperative management is crucial for optimal bone healing.

How does bone formation typically progress after an open-wedge high tibial osteotomy (OWHTO), and what role does plate removal play in this process?

Bone formation after open-wedge high tibial osteotomy (OWHTO) typically progresses from the lateral hinge (outer side) towards the medial side (inner side) of the osteotomy gap. The study emphasizes that gap filling continues to advance even after plate removal, without negatively affecting the corrected knee alignment. This progression is monitored using X-rays and CT scans to assess the development of trabecular bone continuity within the gap. Understanding this pattern helps surgeons and patients track the healing progress and address any potential delays.

What is the recommended approach for patients to ensure optimal healing and a smooth recovery after undergoing open-wedge high tibial osteotomy (OWHTO)?

After open-wedge high tibial osteotomy (OWHTO), both the patient and the surgical team must work together for a successful recovery. It's important to openly discuss any concerns with your healthcare provider and actively participate in the rehabilitation program. By understanding the risk factors, like large opening gaps, unstable hinge fractures, and osteotomy line placement below the safe zone, and following postoperative guidelines, patients can significantly improve their chances of a smooth and timely recovery. Staying informed and proactive is key to getting back to your desired activities.

How was bone formation monitored and evaluated in the research study following the open-wedge high tibial osteotomy (OWHTO) procedure?

The research tracked bone formation within the osteotomy gap after open-wedge high tibial osteotomy (OWHTO) using X-rays and computed tomography (CT) scans. The gap was divided into distinct zones to assess how bone healing progressed from the lateral hinge towards the medial side of the knee. Researchers evaluated bone formation at 3, 6, and 12 months postoperatively, at the time of plate removal, and at the final follow-up, which averaged 62.3 months. This thorough monitoring helps identify any delays in healing and allows for timely interventions.