Book Appointment Chat on Whatsapp Contact us Mail Us

Make an Appointment


    Knee Preservation (HTO)

    Osteoarthritis of the knee is a troublesome and disabling disorder. A few years ago, there were not very many options other than arthroplasty (joint replacement) for knee pain. Joint replacement for osteoarthritis is the ultimate treatment option even now, but only for those who are above 60 years of age and for those who are not going to put lot of load on the artificial joints.

    For a young patient of less than 60 years, or a very active person or a person involved in demanding sports, who has pain in the knee joint, especially on walking or prolonged standing and is beginning to loose the cartilage cushion in the knee on x-ray, the High Tibial Osteotomy (HTO) is the procedure which adds life to the knee.

    When the cartilage cover is lost, bones of the knee joint start to grind on each other giving rise to pain and overloading one side of the joint. The general tendency is to ignore the pain or take painkillers and continue with the daily activities. As this goes on, the knees get worn out and then there is nothing much left to do other than a joint replacement. But if tackled in the initial stages by HTO one gets complete relief from pain, the degenerative process slows down and one can lead a healthy and active lifestyle. Once HTO is done, depending on the initial damage a joint replacement surgery can be postponed either by about 15 years or may not require a knee replacement altogether.

    In HTO, the tibia is cut through 1cm incision and straightened. The bone is fixed using either an external fixator or a bone plate. The fixator assists in gradual and accurate correction of the bone in the postoperative period whereas the plate helps to maintain the correction achieved immediately in the surgery. The hospital stay is about 5 days and the procedure is virtually painless. The load distribution of the joint is corrected and the degeneration slows down. The joint space also becomes normal with time as the cartilage “grows back.”

    This is similar to wheel balancing; when the tyres are not in alignment what they need is correction of alignment and not replacement. Similarly when the malalignment of the leg is tackled by this kind of procedure the balancing of natural knee is achieved with good results.

    High Tibial Osteotomy is not a new procedure. It has been described in medical literature from as early as 1950s. The procedure described was a closing wedge osteotomy, where a wedge of bone was removed from the upper tibia (leg bone close to knee) and upper fibula (smaller leg bone next to tibia). This would change the shape of the bone and therefore cause difficulties in future knee replacement surgery. This is the reason that HTO is not the preferred treatment modality in the minds of many Orthopedic surgeons. Another reason that is often told to the patient is that the results last for only 5-7 years.

    At the Center for Limb Lengthening & Reconstruction, Mnagal Anand Hospital, Mumbai, we are dedicated to revive the art of osteotomy & its benefits. HTO at our center is performed using minimally invasive open wedge technique. The gap which is created by the open wedge gradually fills up with new bone naturally. Since bone is not excised, the shape of the bone is not changed, therefore no complications for a future knee replacement if required. Studies have been done and are still ongoing regarding the benefits of a properly done HTO. They have all proven that if the angle is corrected within a narrow margin of 3-5∘then the results can last 15 years or more. To achieve such an accurate correction we recommend the use of an external fixator which allows us to fine tune the correction to a degree and guarantees good and long lasting results.

    There are other methods for assisting the open wedge technique of HTO performed at the Center for Limb Lengthening & Reconstruction, Mnagal Anand Hospital, Mumbai. These methods are:

    • The Tomofix type of internal fixation (a locking plate which is applied on the inside - thereby nothing is seen from outside)
    • Hexapod Fixator (an external fixator with rings and a six-axis correction system). There are advantages and disadvantages to each method and these can be discussed in detail at the time of consultation.

    An example of correction of a uniplanar deformity in the proximal tibia.

    The picture on extreme left shows that the patient had varus deformity of the proximal tibia i.e. bow legs (reduced angle at the bone close to knee) on both the sides, with the mechanical axis of the lower limbs (load bearing axis from the hip to the ankle) passing on the inner side of both the knees (normally the line should be passing from the center of the knee).

    The picture second from left shows the post surgery status about 4 weeks after surgery (High tibial Osteotomy using an Orthofix fixator). The deformity has been corrected by gradual distraction of 1mm per day. The patient is walking with the aid of a pair of axillary crutches.

    The picture on the extreme right shows the actual incision of about 1.25cm made for the percutaneous osteotomy (minimally invasive technique for cutting the bone).

    The picture second from right was taken 2 weeks after fixator removal. The left side shows excellent correction as compared to the right side, which is yet to be operated.

    The xray pictures during the gradual distraction process of high tibial osteotomy.

    The picture on the left is taken after surgery, before the distraction is begun. The distraction is started 5-7 days after surgery. This helps in initiation of the healing process and better formation of regenerate. The lines drawn show the angle between the joint line of tibia and the anatomic axis of tibia. The inner angle is reduced in this case.

    The picture in the center shows an increasing gap at the osteotomy site (marked by arrow). With the increase in the distraction gap the inner angle is also increasing.

    The picture on the right side is taken at the completion of the distraction process, the gap at the osteotomy site(marked by arrow) has opened up sufficiently, the inner angle has increased to the required amount.

    The final result as shown in the clinical pictures, full length x-ray and spot film of the knee.

    The full length x-ray (second from right) confirms the mechanical axis is central again on the left side whereas the unoperated side axis is passing medial to the knee.

    The spot film (extreme right) confirms a 5º femoro-tibial valgus angle (normal femoro-tibial angle is 3-5º).

    Make an Appointment


      Our Doctors

      Dr. Mangal Parihar

      MS Orthopaedics, MBBS
      Speciality Orthopedist, Joint Replacement Surgeon
      Consulting Room 202
      Consultation
      Timing
      Monday, Wednesday and Friday
      3 pm - 8 pm

      Dr. Anand Parihar

      MD - Radiodiagnosis, DMRD, MBBS
      Speciality Radiologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Maya Parihar Malhotra

      MD - Pathology
      Speciality Pathologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Divya Ahuja

      DNB Orthopedics
      Speciality Orthopaedics
      Consulting Room 203
      Consultation
      Timing
      Tuesday and Thursday,Saturday
      4pm - 7pm ,1pm - 4pm

      Dr. Chetan Anchan

      MS-Orthopedics, Trained in Orthopedic Oncology from Tata Memorial Hospital
      Speciality Orthopaedics
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Sunil Arora

      MS - Orthopaedics, MBBS
      Speciality Orthopaedics
      Consulting Room 205
      Consultation
      Timing
      Monday to Saturday
      11am - 1 pm

      Dr. Prasad Chaudhari

      MS - Orthopaedics, DNB - Orthopedics
      Speciality Orthopaedics
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Kaustubh Durve

      MS -Orthopedics, MRCS (UK)
      Speciality Orthopaedics
      Consulting Room 004
      Consultation
      Timing
      On Appointment

      Dr. Hitesh Kubadia

      DNB - Orthopedics
      Speciality Orthopaedics
      Consulting Room 002
      Consultation
      Timing
      On Appointment

      Dr. Abhishek Kini

      DNB Orthopedics/Orthopedic Surgery, MBBS
      Speciality Foot & Ankle Surgeon
      Consulting Room 202
      Consultation
      Timing
      Wednesday
      7pm - 8pm

      Dr. Parag Lad

      Diploma Orthopedics, FCPS - Orthopedics
      Speciality Hand Surgeon
      Consulting Room 003
      Consultation
      Timing
      Wednesday
      3.30pm to 5pm

      Dr. Kunal Makhija

      MS - Orthopedics
      Speciality Joint Replacement
      Consulting Room 005
      Consultation
      Timing
      Tuesday, Thursday and Saturday
      3pm - 4pm

      Dr. Sheetal Mohite

      MS - Orthopedics, Fellowship in spine
      Speciality Spine
      Consulting Room 205
      Consultation
      Timing
      Wednesday, Saturday
      5:30pm - 7pm, 10am - 11am

      Dr. Pradip Nemade

      MS - Orthopedics, DNB - Orthopedics
      Speciality Arthroscopy & Trauma
      Consulting Room Ground floor, Room no.3
      Consultation
      Timing
      Monday, Wednesday and Friday
      6pm - 7 pm

      Dr. Chasanal Rathod

      MS - Orthopedics, Fellowship in Pediatric Orthopedics
      Speciality Pediatric Orthopedics
      Consulting Room Ground floor, room no. 1
      Consultation
      Timing
      Mondays
      3pm - 5pm

      Dr. Dipit Sahu

      MS - Orthopedics, Fellowship in Shoulder Surgery
      Speciality Orthopedics
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Milind Sawant

      MS - Orthopedics, FRCS Trauma & Orth
      Speciality Joint Replacement
      Consulting Room 203
      Consultation
      Timing
      Saturday
      2pm - 3pm

      Dr. Amandeep Singh Gujral

      DNB - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 204
      Consultation
      Timing
      Tuesday and Thursday
      7pm - 8pm

      Dr. Raghuprasad Verma

      MS - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Swaroop Hegde

      MD - General Medicine and Endocrinology
      Speciality General Medicine
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Antima Jain

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      8am to 1pm

      Dr. Kusumlata

      BPT - Bachelor of Physiotherapy, MPT
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      5pm - 9pm

      Dr. Kanchan Suvasia

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      4pm - 7pm

      Dr. Sauramibika Tiwari

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      9am - 2pm

      Dr. Suman Bijlani

      MBBS, MD - Obstetrics & Gynaecology, DGO, FCPS - Mid. & Gynae
      Speciality Gynecologist
      Consulting Room 203
      Consultation
      Timing
      On Appointment

      Dr. Preeti Jobalia

      DGO - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 003
      Consultation
      Timing
      On Appointment

      Dr. Shilpa Shah

      DNB - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 001
      Consultation
      Timing
      On Appointment

      Dr. Vidula Daundkar

      MS - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Ashutosh Kharche

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Vascular Surgeon
      Consulting Room 203
      Consultation
      Timing
      Tuesday and Friday
      8pm - 9pm

      Dr. Amit Sahu

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Interventional Radiology
      Consulting Room 205
      Consultation
      Timing
      On Appointment

      Dr. Satish Chougale

      MD - Anesthesiology
      Speciality Anesthesiology
      Consulting Room 002
      Consultation
      Timing
      On Appointment

      Dr. Sayali

      Diploma in Anesthesiology
      Speciality Anesthesiology
      Consulting Room 003
      Consultation
      Timing
      On Appointment

      Dr. Sheetal

      Speciality Anesthesiology
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Suratkal

      MBBS, DNB Nephrology
      Speciality Nephrologist
      Consulting Room 201
      Consultation
      Timing
      Monday, Wednesday and Friday
      11am - 1pm

      Dr. Ashish Agrahari

      MD Pathology
      Speciality Pathologist
      Consulting Room 203
      Consultation
      Timing
      On Appointment

      Dr. Akshay Deshpande

      MCH - Plastic & Reconstructive Surgery
      Speciality Plastic & Reconstructive
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Amit Patil

      MBBS, MCh - Plastic Surgery, MS - General Surgery
      Speciality Plastic & Reconstructive Surgery
      Consulting Room 004
      Consultation
      Timing
      On Appointment

      Dr. Tushar Jadhav

      DNB - Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Devashri Patil

      MS - ENT, Fellowship in Head and Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 001
      Consultation
      Timing
      On Appointment

      Dr. Ankit Shah

      MDS & Fellowship in Head & Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Dimple Chudgar

      DNB (Obstetrics & Gynecology), Fellowship in Reproductive Medicine and Endoscopic Surgery
      Speciality Obstetrics & Gynecology
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Sanjay Singh

      DNB (Orthopedics), Fellowship in Shoulder & Elbow
      Speciality Shoulder & Elbow Surgery
      Consulting Room 203
      Consultation
      Timing
      On Appointment

      Our Doctors

      Dr. Mangal Parihar

      MS Orthopaedics, MBBS
      Speciality Orthopedist, Joint Replacement Surgeon
      Consulting Room 202
      Consultation
      Timing
      Monday, Wednesday and Friday
      3 pm - 8 pm

      Dr. Anand Parihar

      MD - Radiodiagnosis, DMRD, MBBS
      Speciality Radiologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Maya Parihar Malhotra

      MD - Pathology
      Speciality Pathologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Divya Ahuja

      DNB Orthopedics
      Speciality Orthopaedics
      Consulting Room 203
      Consultation
      Timing
      Tuesday and Thursday,Saturday
      4pm - 7pm ,1pm - 4pm

      Dr. Chetan Anchan

      MS-Orthopedics, Trained in Orthopedic Oncology from Tata Memorial Hospital
      Speciality Orthopaedics
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Sunil Arora

      MS - Orthopaedics, MBBS
      Speciality Orthopaedics
      Consulting Room 205
      Consultation
      Timing
      Monday to Saturday
      11am - 1 pm

      Dr. Prasad Chaudhari

      MS - Orthopaedics, DNB - Orthopedics
      Speciality Orthopaedics
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Kaustubh Durve

      MS -Orthopedics, MRCS (UK)
      Speciality Orthopaedics
      Consulting Room 004
      Consultation
      Timing
      On Appointment

      Dr. Hitesh Kubadia

      DNB - Orthopedics
      Speciality Orthopaedics
      Consulting Room 002
      Consultation
      Timing
      On Appointment

      Dr. Abhishek Kini

      DNB - Orthopedics, Dip. Sports Medicine from IOC
      Speciality Foot & Ankle Surgeon
      Consulting Room 202
      Consultation
      Timing
      Wednesday
      7pm - 8pm

      Dr. Parag Lad

      Diploma Orthopedics, FCPS - Orthopedics
      Speciality Hand Surgeon
      Consulting Room 003
      Consultation
      Timing
      Wednesday
      3.30pm to 5pm

      Dr. Kunal Makhija

      MS - Orthopedics
      Speciality Joint Replacement
      Consulting Room 005
      Consultation
      Timing
      Tuesday, Thursday and Saturday
      3pm - 4pm

      Dr. Sheetal Mohite

      MS - Orthopedics, Fellowship in spine
      Speciality Spine
      Consulting Room 205
      Consultation
      Timing
      Wednesday, Saturday
      5:30pm - 7pm, 10am - 11am

      Dr. Pradip Nemade

      MS - Orthopedics, DNB - Orthopedics
      Speciality Arthroscopy & Trauma
      Consulting Room Ground floor, Room no.3
      Consultation
      Timing
      Monday, Wednesday and Friday
      6pm - 7 pm

      Dr. Chasanal Rathod

      MS - Orthopedics, Fellowship in Pediatric Orthopedics
      Speciality Pediatric Orthopedics
      Consulting Room Ground floor, room no. 1
      Consultation
      Timing
      Mondays
      3pm - 5pm

      Dr. Dipit Sahu

      MS - Orthopedics, Fellowship in Shoulder Surgery
      Speciality Orthopedics
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Milind Sawant

      MS - Orthopedics, FRCS Trauma & Orth
      Speciality Joint Replacement
      Consulting Room 203
      Consultation
      Timing
      Saturday
      2pm - 3pm

      Dr. Amandeep Singh Gujral

      DNB - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 204
      Consultation
      Timing
      Tuesday and Thursday
      7pm - 8pm

      Dr. Raghuprasad Verma

      MS - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Swaroop Hegde

      MD - General Medicine and Endocrinology
      Speciality General Medicine
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Antima Jain

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      8am to 1pm

      Dr. Kusumlata

      BPT - Bachelor of Physiotherapy, MPT
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      5pm - 9pm

      Dr. Kanchan Suvasia

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      4pm - 7pm

      Dr. Sauramibika Tiwari

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      9am - 2pm

      Dr. Suman Bijlani

      MBBS, MD - Obstetrics & Gynaecology, DGO, FCPS - Mid. & Gynae
      Speciality Gynecologist
      Consulting Room 203
      Consultation
      Timing
      On Appointment

      Dr. Preeti Jobalia

      DGO - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 003
      Consultation
      Timing
      On Appointment

      Dr. Shilpa Shah

      DNB - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 001
      Consultation
      Timing
      On Appointment

      Dr. Vidula Daundkar

      MS - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Ashutosh Kharche

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Vascular Surgeon
      Consulting Room 203
      Consultation
      Timing
      Tuesday and Friday
      8pm - 9pm

      Dr. Amit Sahu

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Interventional Radiology
      Consulting Room 205
      Consultation
      Timing
      On Appointment

      Dr. Satish Chougale

      MD - Anesthesiology
      Speciality Anesthesiology
      Consulting Room 002
      Consultation
      Timing
      On Appointment

      Dr. Sayali

      Diploma in Anesthesiology
      Speciality Anesthesiology
      Consulting Room 003
      Consultation
      Timing
      On Appointment

      Dr. Sheetal

      Speciality Anesthesiology
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Suratkal

      MBBS, DNB Nephrology
      Speciality Nephrologist
      Consulting Room 201
      Consultation
      Timing
      Monday, Wednesday and Friday
      11am - 1pm

      Dr. Ashish Agrahari

      MD Pathology
      Speciality Pathologist
      Consulting Room 203
      Consultation
      Timing
      On Appointment

      Dr. Akshay Deshpande

      MCH - Plastic & Reconstructive Surgery
      Speciality Plastic & Reconstructive
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Amit Patil

      MCH - Plastic & Reconstructive Surgery
      Speciality Plastic & Reconstructive Surgery
      Consulting Room 004
      Consultation
      Timing
      On Appointment

      Dr. Tushar Jadhav

      DNB - Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Devashri Patil

      MS - ENT, Fellowship in Head and Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 001
      Consultation
      Timing
      On Appointment

      Dr. Ankit Shah

      MDS & Fellowship in Head & Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Dimple Chudgar

      DNB (Obstetrics & Gynecology), Fellowship in Reproductive Medicine and Endoscopic Surgery
      Speciality Obstetrics & Gynecology
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Sanjay Singh

      DNB (Orthopedics), Fellowship in Shoulder & Elbow
      Speciality Shoulder & Elbow Surgery
      Consulting Room 203
      Consultation
      Timing
      On Appointment

      Our Vision & Mission

      Our Vision दृष्टिकोन:
      To improve the quality of life; free of deformities for our patients, at an affordable price while always treating them like a family.
      आमच्या रुग्णांच्या जीवनाचा दर्जा सुधारण्यासाठी त्यांस परवडणाऱ्या किंमतीत आरोग्य सेवा देणे. तसेच त्यांच्या सोबत नेहमी कुटुंबाप्रमाणे वागणे.

      Our Mission मोहीम:
      To provide the best, empathetic medical care to our patients. To help our patients make an informed choice in their treatment. To pass on the knowledge we have received to our collegues and to the next generation.
      आमच्या रुग्णांना सर्वोत्तम, सहानुभूतीपूर्ण वैद्यकीय सेवा प्रदान करणे. आमच्या रुग्णांना त्यांच्या उपचारांमध्ये माहितीपूर्ण निवड करण्यास मदत करणे. आम्हाला मिळालेले ज्ञान आमच्या सहकाऱ्यांना आणि पुढच्या पिढीपर्यंत पोहोचवणे.