High Tibial Osteotomy (HTO)

First 10 days

Activity

1. Elevate your knee and leg above your heart as much as possible, especially the first few days to minimize swelling. Avoid pillows under the knee. Place pillows under the calf or ankle.
2. Ice the knee at least 4 times per day (try breakfast, lunch, dinner, bedtime) for 20 minutes each time. Alternatively, use an ice machine such as a Cryo-Cuff as directed.
3. You may walk using crutches but NO WEIGHT bearing on operated leg. Keep the knee immobilizer in place with your knee in full extension when sleeping and walking.
4. You can remove the dressings on postop day 3, and then shower and get the incisions wet.
5. If you experience numbness, tingling, pain in your foot or toes, you can roll down your TED hose stocking. Do not remove the TED hose stocking completely – it is there to control swelling. You DO NOT have to wear on opposite leg
6. Do not place any weight on the leg for 4 weeks, we will direct you when you may begin increasing your weight bearing.
7. Start bending your knee tomorrow doing heel slides. You will have to do on buccal the knee immobilizer in order to start bending your knee.
8. Start moving your ankle up and down as well as contracting your quadriceps muscle. Please do this routinely throughout the day.

Medications

1. Resume all your regular medicines as prescribed.
2. Drink plenty of water.
3. Take the pain medications as prescribed and as needed for pain. Please wean off of using the narcotics.
4. Do not take any anti-inflammatories for 6 weeks (Ibuprofen, motrin, aleve) as this slows the bone healing.
5. Start taking aspirin 81 mg once a day tomorrow for 6 weeks to help prevent a blood clot.

Wound Care

1. Please keep dressings clean dry and intact for the next three days. On postop day 3 after surgery, you may remove the TED hose stocking and dressings on your knee. Do not remove the tapes on your knee called Steri-Strips until 2 weeks after surgery. You may shower and get your knee wet. However, do not soak your wounds, no baths, no pools, no spas. After showering, please dry your wound and replace the TED hose stocking. If there is any using from your wound, please place some dry dressings over the incision site.
2. Expect some bloody drainage on your surgical dressing. This is normal. You may change the gauze under the TED Hose stocking if necessary, then re-wrap your knee.
3. Make sure you have an appointment scheduled for a wound check in 2 weeks. You will need to get x-rays prior to each visit. If you did not get the x-ray orders on your preoperative visit, please contact our office. These x-ray should be performed at 2 weeks postop.

Early Rehabilitation Exercises

Dedicate 30 minutes 3 times per day to the following exercises:

1. Quad sets – Contract quads for 30 secions then relax. Start the 10, then 20, etc.
2. Straight leg raises in the brace.
3. Towel Roll – Place a rolled towel about 3 inches thick under your ankle. Allow knee to fully extend and contract leg muscles to straighten the knee.
4. Start bending your knee tomorrow.

Call my office at 916-732-3005/916-732-3000 (during the day) or the advice nurse after hours for the following:

1. Increasing pain or pain not controlled by ice or medications prescribed.
2. Large amounts of bloody drainage.
3. Foul smelling drainage from the surgical site.
4. Swelling.
5. Rash.
6. Fever (over 101F) or chills.
7. Increasing redness/warmth/hardness around wounds.
8. Inability to eat or urinate.
9. Persistent numbness and/or tingling not present before surgery, or by loosening the ACE bandage.
10. Cold or blue toes.
11. Any other signs that concern you.

Follow Up Appointment Information

Call to schedule follow up appointment for 14 days, 916-732-3005. You will require xrays before each follow up appointment, so please allow extra time to obtain them on the day of your appointment.

Please obtain the postop range of motion brace from Pacific Medical..

Physical therapy appointment: start immediately

Questions and Concerns

Please call our office at 916-732-3005 for any questions or concerns. You can also contact our office directly by using the Klara texting application. You can respond to the text messages sent by our office or your can initiate a new conversation by clicking on the purple “MESSAGE US” at the bottom of my webpage. www.sacorthosports.com

Greg Takenishi, MD
Sacramento Orthopedic Sports & Shoulder
Sacramento River Cats Head Team physician
San Francisco Giants Team physician
www.sacorthosports.com