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  3. Medial Opening-wedge High Tibial Osteotomy.
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  3. Medial Opening-wedge High Tibial Osteotomy.

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Medial Opening-Wedge High Tibial Osteotomy.

Jason S Hoellwarth1, Jason D Gross2, Austin T Fragomen1

  • 1Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY.

JBJS Essential Surgical Techniques
|March 25, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Medial opening-wedge high tibial osteotomy corrects knee malalignment, reducing pain and improving mobility. This joint-preserving surgery is ideal for active patients seeking to delay knee replacement.

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Area of Science:

  • Orthopedic Surgery
  • Biomechanics
  • Sports Medicine

Background:

  • Mechanical axis deviation (MAD) causes abnormal knee joint loading, leading to cartilage degeneration, gait issues, and reduced mobility.
  • Varus MAD, often centered in the proximal tibia, can be corrected with a medial opening-wedge high tibial osteotomy (MOWHTO).
  • This procedure aims to reduce medial knee compartment stress, improving pain, function, and quality of life.

Purpose of the Study:

  • To describe the surgical technique and rationale for medial opening-wedge high tibial osteotomy (MOWHTO).
  • To highlight MOWHTO as a joint-preserving alternative for correcting varus knee malalignment.
  • To compare MOWHTO with other treatment options for knee deformities.

Main Methods:

  • Preoperative assessment includes patient history, physical examination, and radiographic analysis (hip-to-ankle AP, knee AP/flexion/lateral views) to determine the center of rotation and angulation (CORA).
  • The surgical technique involves a medial approach to the proximal tibia, a biplanar osteotomy, opening of the wedge, fixation with a plate and screws, and closure.
  • Key considerations include careful preoperative planning, intraoperative alignment checks, and postoperative weight-bearing restrictions.

    • Main Results:

    • MOWHTO normalizes knee joint loading, alleviating pain and improving gait.
    • The procedure preserves the native knee joint, allowing for higher activity levels compared to total knee arthroplasty (TKA).
    • The medial approach is technically simpler and safer than a lateral closing-wedge osteotomy.

    Conclusions:

    • MOWHTO is an effective joint-preserving procedure for correcting proximal tibia-based varus malalignment.
    • It is particularly suitable for young, active patients aiming to delay or avoid TKA.
    • Expected outcomes include pain improvement, balanced gait, and enhanced mobility, while preserving future TKA options.