High Tibial Osteotomy in Turkey

When osteoarthritis of the knee is concentrated on the inner side and is accompanied by bowing of the legs outward, many patients feel pain when walking and climbing stairs, and find their daily or sporting activity declining, at an age when they are not yet ready for an artificial joint. In such cases, an orthopedic surgeon may propose an operation called high tibial osteotomy (HTO).

The idea of the operation is to reshape the leg surgically so that part of the load carried by the damaged side of the knee is shifted to the healthier side. The aim is to relieve pain and keep the natural joint for longer, not to return the knee to the state it was in before arthritis.

Let us be clear from the start: HTO may be an alternative to knee replacement for some carefully selected patients, but it is not a suitable alternative for everyone with knee osteoarthritis, and it does not mean that its results are better than replacement in every case. Suitability is not decided by bowed legs or arthritis alone, but by a precise analysis of the leg’s alignment, the condition of the cartilage in the different parts of the knee, the stability of the ligaments, and the patient’s age, activity and goals.

This guide explains the operation and how its suitability is determined, compares it with partial and total knee replacement, and then covers what matters to anyone considering high tibial osteotomy in Turkey: the assessment before travel, the cost, follow-up after returning home, and the questions worth asking your surgeon. Every figure given here is stated together with the study it came from, the definition of the outcome and the length of follow-up where available, because published figures do not automatically apply to every patient.

What Is High Tibial Osteotomy (HTO)?

The word “osteotomy” means cutting a bone surgically in order to change its orientation. In HTO, the surgeon makes a cut in the upper part of the tibia (the main bone of the lower leg) just below the knee, changes the angle of the bone by a calculated amount, and fixes it with a metal plate and screws until it heals in its new position.

It is not a “replacement” operation: the joint surfaces are not removed and no artificial joint is implanted. Your natural joint stays, and only the direction of the load passing through it changes. For this reason it is classed among joint-preserving operations.

There are two main techniques: the medial opening-wedge osteotomy, in which the bone is opened on the inner side in a wedge shape, and the lateral closing-wedge osteotomy, in which a small wedge of bone is removed on the outer side and the bone is closed. We explain the difference in the section “Types and Techniques of Tibial Osteotomy”.

Why Is the Cut Made in the Upper Tibia?

In a healthy leg, the weight-bearing line passes roughly through the middle of the knee, so body weight is shared between its inner and outer sides. In bowed legs (varus alignment), this line passes toward the inner side, so the inner part of the knee carries more pressure and its cartilage may wear faster. This is the link between leg alignment and the development of inner-side (medial) osteoarthritis.

The imaginary line from the centre of the hip joint to the centre of the ankle is called the mechanical axis of the lower limb. When this axis deviates toward the inside, the load becomes unbalanced. Changing the angle of the bone moves the weight-bearing line toward the healthier side of the knee.

The cut is usually made in the upper tibia because the deformity is often there, and because cutting near the joint allows correction while the joint itself is preserved. But not every bowleg originates in the tibia; it may be in the femur, or in both, and this is what axis analysis determines (see the diagnosis section).

It is worth noting that redistributing the load does not rebuild damaged cartilage and does not mean the arthritis disappears; it reduces the load on the damaged part and may ease symptoms in selected patients.

Cases That May Benefit From the Operation

HTO is usually proposed for patients in whom several features come together, including:

• Pain concentrated on the inner side of the knee.
• Outward bowing of the legs (varus) confirmed by examination and imaging.
• Osteoarthritis of the inner compartment (medial compartment osteoarthritis) without severe damage to the rest of the knee.
• A wish to keep the natural joint, and an activity level that makes an artificial joint less suited to the patient’s goals.
• An outer compartment and a patellofemoral joint (between the kneecap and the thigh bone) in acceptable condition.
• Stable ligaments, or instability that can be treated as part of the plan.

Damage to the meniscus or the articular cartilage may also be treated in the same session when there is a reason to (see the section on combined procedures).

Even so, the presence of bowing or arthritis is not enough to justify the operation. The arthritis may be spread across more than one part of the knee, the deformity may be complex, or the source of the pain may be something else. The consensus of the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) holds that the indications for osteotomy around the knee are broader than traditionally thought, but only if a strict planning process is followed that includes deformity analysis.

Who Is a Suitable Candidate, and When Is the Operation Less Suitable?

There is no single formula that identifies the suitable candidate. The surgeon weighs several factors:

• Age, sex and weight: the ESSKA consensus states that there is no reliable evidence for excluding patients because of age, sex or weight alone, and recommends an individual approach. In other words, age alone does not decide, but general health, activity level and the condition of the joint are taken into account. The likelihood of some complications may rise in patients with a very high body weight, and this is assessed individually.
• Smoking: the consensus recommends stopping, because smoking has been linked in studies to delayed bone healing and more complications.
• Degree of arthritis and cartilage condition: the less the arthritis in the inner compartment and the healthier the outer compartment, the greater the suitability. The consensus holds that mild degrees of arthritis in the outer compartment or the patellofemoral joint may be accepted in certain cases.
• Degree and source of the bowing: determined by axis analysis (see the next section).
• Ligaments: the stability of the knee is an important factor in choosing the procedure.
• Factors that generally reduce suitability: such as severe cartilage damage, advanced arthritis in more than one part of the knee, complex deformities, instability of the knee, active joint infection, and poor bone quality. These factors reduce the chances of success or change the plan; they are not all absolute contraindications, and the decision rests with the surgeon after examination.

What about advanced arthritis? In a systematic review of 18 studies and 1,296 knees with advanced arthritis (grade 3 or higher on the Kellgren-Lawrence scale or its equivalent), the average survival without needing knee replacement was about 74.6% at 10 years, but with a wide range between studies (from 60% to 98.1%). “Survival” here was defined as not needing knee replacement. The studies were observational (level IV evidence). This indicates that some patients benefit even with advanced arthritis, but it does not mean that HTO is suitable for every advanced arthritis.

If the arthritis is advanced in several parts of the knee, or the cartilage is severely damaged, or the deformity is complex, replacement may be more suitable (see the comparison section).

How Is the Condition Diagnosed and the Leg Axis Analyzed?

This is the most important section in the decision about the operation, because the suitability of HTO is not determined by bowing or arthritis alone. The ESSKA consensus stresses that deformity analysis is essential to determine the shape of the bone, the location of the deformity and the right choice of procedure, and that good-quality images of the lower limb and the knee are a prerequisite for planning.

Examination and Imaging

• Clinical examination: the site of pain, the walking pattern, the range of motion of the knee, the stability of the ligaments, and any previous surgery.
• Standing X-rays: images of both knees taken with weight on them. Most important is the full-length image of the lower limb from hip to ankle (Long-Leg Standing X-ray), which allows the axis to be measured.
• Magnetic resonance imaging (MRI): the surgeon may request it to assess the cartilage, the menisci and the ligaments when needed.
• Computed tomography (CT): may be requested in complex deformities, when a rotational problem is suspected, or for three-dimensional planning in some techniques.

The Mechanical Axis and the Weight-Bearing Line

The mechanical axis is the line from the centre of the femoral head to the centre of the ankle. The weight-bearing line (WBL) is the line along which weight is transmitted, and attention is paid to where it crosses the tibial plateau: toward the inside, near the centre, or toward the outside. In a knee bowed outward, the line usually passes to the inside, and the aim of correction is to move it to a position chosen by the surgeon. This position is not one number for all patients; it is affected by the condition of the cartilage in each compartment and by other factors, which is why we do not give a fixed number for it here.

The Measurements: MPTA, LDFA and JLCA

The surgeon uses three main angles to identify the source of the deformity:

• MPTA (Medial Proximal Tibial Angle): the inner angle between the mechanical axis of the tibia and the line across the tibial plateau. The reference value is about 87° (between 85° and 90°).
• LDFA (Lateral Distal Femoral Angle): the outer angle between the mechanical axis of the femur and the line across the femoral condyles. The reference value is about 88° (between 85° and 90°).
• JLCA (Joint Line Convergence Angle): the angle between the joint lines of the femur and the tibia; it reflects ligament laxity or cartilage loss inside the joint. The reference value is between 0° and 2°, and a larger value is taken into account in planning.

These are reference values based on Paley’s measurements, which the ESSKA consensus recommended, and they differ between individuals, ethnic groups and the sexes. They are used to locate the deformity; they are not targets for correction and not rules applying to every patient.

Where Is the Deformity?

The source of the bowing may be in the tibia (so the MPTA is lower than usual), or in the femur (so the LDFA is higher than usual), or in both, or inside the joint itself because of cartilage loss or ligament laxity (so the JLCA increases). Identifying the source changes the plan, which is why the consensus stresses performing the correction at the right level, which may require a double-level cut.

How Does the Surgeon Decide the Amount of Correction?

There is no single formula for all patients. The surgeon plans on the X-rays (often with planning software) to choose the correction angle that moves the weight-bearing line to the intended position, and the goals differ according to the condition of the cartilage, the cause of the deformity and the patient’s goal. To illustrate how cases differ: in a single-centre series of 651 knees treated with medial opening-wedge osteotomy, the mean planned correction was about 7.6° with a standard deviation of 2.9°, meaning that the amount varies from one patient to another. This is an illustrative example from one centre, not a target to be followed.

When Is a Double-Level Osteotomy Considered?

A double-level osteotomy (DLO) is a procedure with two cuts: one in the tibia and one in the femur. It is considered when part of the deformity is in the femur, or when correcting the tibia alone would lead to excessive tilt of the joint line (joint line obliquity). The ESSKA consensus pointed to the tilt of the joint line after correction as a planning consideration, with a general limit of around 5 degrees. This is a planning guide from an expert consensus, not a fixed rule applying to every case, and the surgeon decides according to the individual situation.

Types and Techniques of Tibial Osteotomy

• Medial opening-wedge osteotomy: the bone is cut from the inner side and then opened gradually into a wedge until the planned angle is reached, and fixed with a plate and screws. It is the most widely used technique in modern practice, as described by the ESSKA consensus.
• Lateral closing-wedge osteotomy: a small wedge of bone is removed from the outer side, then the bone is closed and fixed. Because the peroneal nerve lies close to this area, researchers report injury to it as a complication specific to this type (see the complications section).
• Biplanar osteotomy: the surgeon adds a second cut at a different angle, aiming to increase the stability of the bone and speed its healing, according to the ESSKA consensus.
• Computer-assisted planning and patient-specific instrumentation: the consensus holds that patient-specific cutting guides should be limited to complex cases and to experienced surgeons. They are not necessary for every patient.

Is one type better than another? The evidence does not settle the question in favour of a single technique. A systematic review published in 2025 (40 studies, level IV evidence) found similar survival between the two types at 10 years, while three comparative studies pointed to a higher rate of conversion to knee replacement after the closing wedge. An older meta-analysis (2017) saw a difference at 10 years in favour of the opening wedge, but the number of opening-wedge studies at that follow-up was small and publication bias was possible. A 2023 meta-analysis of trials found the two types comparable. The surgeon therefore chooses the technique according to the anatomy, the source of the deformity, the amount of correction and his or her own experience, and it is not correct to say that one is better for everyone.

How Is the Operation Performed?

What follows is a general description compiled from technical accounts by different surgeons. It is not a single protocol; details vary from surgeon to surgeon and from hospital to hospital:

1. Anaesthesia: it varies with the centre and the patient’s condition; sources mention general, spinal or, in some techniques, local anaesthesia.
2. Arthroscopy (if needed): the surgeon may begin with arthroscopy of the knee to assess the cartilage and to treat meniscal damage where there is a reason to.
3. Incision and marking the cut: a skin incision on the front-inner side below the knee, then guide wires are placed and their position is checked with imaging during the operation.
4. The cut: made with a fine saw, leaving the outer layer of bone intact to act as a hinge around which the bone rotates. ESSKA places the ideal hinge position at the upper level of the proximal tibiofibular joint, and does not consider extra hinge protection always necessary.
5. Opening or closing the bone: gradually, until the planned angle is reached.
6. Fixation: with a metal plate and screws. The evidence supports the use of locking plates in the opening-wedge technique.
7. Filling the bone gap: the gap created by opening the bone may be left unfilled, or filled with a bone graft or bone substitute when the surgeon wants additional support. ESSKA does not regard filling as mandatory in every case.

The role of the plate and screws: they hold the bone in its new position until it heals, and the surgeon decides the type according to the technique.

What we do not give here: we do not state the duration of the operation in minutes or the length of the hospital stay, because we found no reliable source that sets a single figure for them; they vary with the technique, the patient’s condition and the hospital.

Benefits of the Operation and Expected Results

HTO aims to relieve symptoms caused by excess load on the damaged part, to keep the natural joint for longer, and to delay the need for knee replacement in suitable patients.

How are results measured? Before presenting figures, it is important to distinguish between different indicators, which are not interchangeable:

• Conversion to knee replacement: the proportion of patients who later needed knee replacement within a given follow-up period.
• Survival without replacement (survivorship): the flip side of conversion, that is, those who did not need replacement during the same period.
• Pain and function: measured with different scales across studies, which is why we do not give a single figure for them.
• Return to sport or work.

For this reason, this article does not give a single “success rate” for the operation; the word “success” may mean pain relief, avoiding replacement for a defined period, or return to sport, and each is measured differently.

How many patients need knee replacement later? The figures differ with study design:

• In a Canadian single-centre study of 643 HTO procedures in 556 patients, performed by four surgeons using the medial opening wedge, the estimated cumulative need for knee replacement was about 5% at 5 years and about 21% at 10 years, meaning that about 79% did not need replacement within 10 years. The strongest predictor of needing replacement was the severity of the radiographic changes in the knee before surgery, and the study had no control group.
• In a meta-analysis (Loke 2025) that pooled 59 studies and 5,162 patients treated with medial opening wedge and plates, the pooled conversion rates were about 4.5% at a mean follow-up of less than 5 years, about 8.3% at 5–10 years, and about 11.2% at more than 10 years.

These figures do not mean the two studies contradict each other. The first is a cumulative estimate from one centre following all of its patients on a uniform time-to-event basis; the second is pooled percentages from different studies, grouped by each study’s mean follow-up, with large differences in patients, surgeons and measurement methods. The two figures should not be placed in one table as if they measured one group.

• In a series from a single specialist centre (651 knees, mean follow-up about 13 years), 9.1% of knees were converted to an artificial joint (5.8% total and 3.2% partial). These are the results of a specialist centre and should not be assumed to be repeated in every centre.
• Published survival figures range between different studies from about 71% to 95% at 5 years, and from about 51% to 98% at 10 years, as summarized by the Loke analysis. This variation is itself an important message: results depend on patient selection, the extent of damage and the experience of the team.

Return to sport: in a systematic review of 19 studies and 1,189 patients (mean follow-up 65 months, level IV), 87.2% returned to sport, 78.6% returned to the same or a higher level than before, and 54% of competitive athletes returned to competition; most returned within a year. The ESSKA consensus expects patients to return to sport within about 6 months. The gap between the two estimates is another example of how sources differ. These percentages are not a promise of an individual result.

Risks and Complications

Like any bone surgery, HTO carries risks. Complication rates vary widely between studies for reasons including: the definition of a complication (which events are counted?), how it is detected (a hinge fracture may be found on plain X-ray or on CT), the length of follow-up, the technique, and the selection of patients. For this reason we present each figure with its source and definition, and do not combine them into a single rate.

The main complications reported in the studies:

• Hinge fracture: a crack in the outer layer of bone that acts as the hinge. It may be minor, or it may lead the surgeon to modify the weight-bearing plan.
• Delayed healing or non-union of the bone.
• Infection: superficial or deep.
• Nerve or blood vessel injury.
• Loss of correction, or imprecise correction (under- or over-correction).
• Irritation from the plate and screws, which may lead to their removal later.
• Venous clots, and the surgeon assesses the need for prevention in each case.
• The need for further surgery.

What the studies say:

• The Miltenberg review (2024), which included 71 studies and 7,836 patients (level IV): complications during surgery were about 5.5% (range between studies 0–29.3%), and complications after surgery about 6.9% (0–26.6%). Hinge fracture was about 9.1% (0–30.4%) in the medial opening wedge, peroneal nerve injury about 3.2% (0–8.7%) in the lateral closing wedge, nerve or vessel injury about 1.1% (0–18.9%), and superficial infection about 2.2% (0–13%).
• The Loke analysis (2025), which concerns the medial opening wedge with plates: overall complications were about 12% (95% confidence interval 9.8–15.6%), non-union about 1.7%, deep infection about 2.0%, superficial infection about 2.6%, and hinge fracture during surgery about 1.6%.

This is where the variation we mean appears: hinge fracture was 9.1% in one review and 1.6% in another, because of differences in definition, method of detection and the patients included. An important point: the figure of “about 12%” is not a fixed rate that applies to all patients and techniques; it comes from a specific analysis of the medial opening wedge with plates, with large variation between studies.

Signs that call for urgent medical assessment: fever, pain that increases instead of settling, redness and swelling that increase, discharge from the wound, opening of the wound, or swelling and pain in the leg with shortness of breath. These call for seeing your surgeon or the emergency department without waiting for the next appointment. The decision on taking samples and on treatment rests with the treating doctor according to the clinical picture and the severity of the case.

Will the Plate Need to Be Removed Later?

Some patients need a second operation to remove the plate and screws, while others keep them. According to the Miltenberg review, the pooled re-operation rate was about 15.5% (range 0–70.7%), and removal of fixation hardware was among its most common reasons at about 10.0% (range 0–60%). The wide range reflects differences in surgeons’ policies and patients’ symptoms, such as irritation of the tissues around the plate. So ask your surgeon in advance: Is the plate expected to be removed? Under what circumstances? And is the cost of that surgery included in the financial offer?

Recovery After the Operation

There is no single timetable that suits all patients, because recovery depends on the type of osteotomy, the amount of correction, the method of fixation, how quickly the bone heals, and the surgeon’s instructions. The American Academy of Orthopaedic Surgeons (AAOS) notes that recovery after knee osteotomy is often longer and harder than after some alternatives because of the limits on putting weight on the leg.

• The first days: controlling pain and swelling, preventing clots as assessed by the surgeon, and starting knee movement and walking with crutches according to instructions.
• Putting weight on the leg: here doctors differ. The ESSKA consensus considers that early full weight-bearing can be adopted regardless of the technique. In a 2023 meta-analysis, no significant differences were found in function, complications or delayed healing between early and delayed full weight-bearing, but the conclusion applied to small corrections, the absence of hinge fracture, and non-smokers. In a randomized trial of 120 patients, those who began partial weight-bearing (20 kg) after 11 days improved faster at 6 months than those who waited 6 weeks, with a locking plate and no bone graft. Even so, the surgeon sets each patient’s plan, and it may change if a hinge fracture occurs, if the patient smokes, or if the correction is large.
• Bone healing: AAOS gives about 6 weeks as a general indicator, but complete filling of the bone gap may take months, and the surgeon follows it with X-rays.
• Physiotherapy: its aims are to restore knee motion, strengthen the muscles, improve walking and control swelling. We do not specify a number of sessions or a uniform duration; the treating team sets that.
• Return to work: in the Loke analysis, the pooled mean was about 3.2 months (confidence interval 2.8–3.6), based on only four studies with very large variation between them. The time depends on the nature of the job and the speed of recovery.
• Driving: we found insufficient data to set a uniform date, and the surgeon decides according to the treated leg and recovery.
• Return to sport: see the results section above; it depends on bone healing and the surgeon’s instructions.

HTO or Partial or Total Knee Replacement?

This is one of the most important comparisons for the patient, and there is no single answer to it; the choice depends on the anatomy, the degree of damage and the patient’s goals. Below is a general comparison, which does not replace the surgeon’s assessment:

High tibial osteotomy (HTO): the natural joint stays and the direction of load through it changes. It is usually proposed for clear bowing with arthritis confined to the inner side, in a patient who wishes to keep the joint. Recovery involves limits on weight-bearing until the bone heals, and it may be longer. The plate may need removal later, and knee replacement may be needed later (see the results section).

Partial knee replacement: only the damaged part of the knee is replaced. It is usually proposed for arthritis confined to one part of the knee with intact ligaments. Recovery varies with the case and the surgeon. Revision or conversion may be needed later, depending on the case.

Total knee replacement: all the joint surfaces are replaced. It is usually proposed for advanced arthritis, or arthritis spread across more than one part of the knee. Recovery varies with the case and the surgeon. The likelihood of later surgery varies with the case and the implant.

We do not give comparative figures here, because the studies that compare these procedures are mostly observational, and their patients differ in age, activity and degree of damage.

What do the studies say?

• HTO versus partial replacement: in a meta-analysis published in 2023 (38 studies, with a search ending in 2020), partial replacement recorded less pain after surgery, fewer complications and a better WOMAC result, while HTO recorded a wider range of motion and a lower re-operation rate, and no significant differences appeared in several other functional measures. A more recent meta-analysis (2025, 39 studies, 56,686 patients) concluded that partial replacement was superior in re-operation, pain, complications and function, so it disagrees with the first analysis on re-operation. Comparisons from observational studies remain affected by patient selection, so it cannot be concluded that the procedure alone is the cause of the difference.
• The need for knee replacement after HTO: in a matched observational study of 73 patients in each group (level III, follow-up of 10 years or more), knee survivorship was higher in young patients who had HTO followed later by knee replacement than in those who had replacement early. But a 2020 meta-analysis found that knee replacement after HTO was associated with more re-operations and complications, while an older review (2009) found no significant differences in some outcomes. The evidence here is inconsistent.
• HTO versus total replacement: within what we reviewed, we found no randomized trial comparing the two procedures directly, so superiority of either cannot be asserted.

In summary: HTO may be a suitable option for preserving the joint in selected patients, and partial or total replacement may be more suitable for others; neither procedure has absolute superiority. So ask your surgeon why he or she considers one option more suitable for your particular case, and what the other options are.

Can HTO Be Combined With Other Procedures?

In some cases the surgeon may recommend additional procedures, but this is not necessary for every patient and depends on the diagnosis:

• Articular cartilage repair: it can be done in the same session in selected patients. In the Loke analysis, the cartilage procedures combined did not significantly change the rate of conversion to replacement, with repair methods differing and some groups small. This means the evidence is not enough to generalize their benefit.
• The meniscus: it is often damaged in knees with arthritis, and the surgeon may treat it arthroscopically in the same session when there is a reason to; you can read about treatment of meniscal tears in Turkey.
• The anterior cruciate ligament: if the knee is unstable because of a torn ligament, correcting the alignment together with ligament reconstruction may be considered in selected cases; the available evidence on this combination is limited. For more on the injury itself: treatment of anterior cruciate ligament tears in Turkey.

Cost of High Tibial Osteotomy in Turkey

The cost of high tibial osteotomy in Turkey can be estimated from USD 3,000 to USD 10,000. This is an initial estimated range; it is not a market average established by an independent study, and it is not a binding price quotation.

What changes the cost? The actual cost varies according to:

• The complexity of the bone deformity and the amount of correction required.
• The type of osteotomy (opening or closing, whether it is double-level, and whether a femoral cut is needed).
• The technique used (such as computer-assisted planning or patient-specific guides).
• The type of metal fixation (plate and screws), and whether a bone graft or substitute is needed.
• Accompanying procedures such as cartilage repair or treatment of the meniscus or ligament.
• The hospital, the type of room and the number of nights of stay.
• The medical services included in the offer.

We do not assume that the estimated price includes any particular service: not the surgeon, nor anaesthesia, nor the hospital, nor the plate, nor physiotherapy, nor accommodation, nor transport, nor follow-up, nor the treatment of complications. This is confirmed only by an actual offer from the hospital.

What should you ask for in the written offer? Ask for a written medical and financial offer that states, for each of the following items, whether it is included, not included, or to be determined later:

• The surgeon’s fees.
• Anaesthesia.
• The hospital and room, and the number of nights.
• The plate and screws (and their type).
• Bone grafts or substitutes if needed.
• Imaging and laboratory tests.
• Accompanying surgical procedures if needed.
• Medication and clot prevention.
• Physiotherapy.
• Accommodation, transport and interpreting.
• Follow-up after you return to your country.
• Removal of fixation hardware in the future if needed.
• Handling complications if they occur, and who bears their cost.

And do not make price your only criterion; the surgeon’s experience with this type of surgery, the precision of the planning and the clarity of the follow-up plan are no less important.

Travelling to Turkey and Follow-Up After Returning Home

For anyone considering high tibial osteotomy in Turkey, good preparation and follow-up after returning home are as much a part of treatment as the operation itself.

Before travelling

• Send the treating team your reports and images: X-rays of both knees, a full-length standing image of the lower limb if available, MRI if one was done, and your medical history, previous surgeries and medications. Assessment of the knee’s mechanical axis is necessary before any decision. This preliminary assessment does not replace examination and imaging on arrival.
• Ask about a surgeon with experience in joint-preserving knee surgery, and about the number of HTO cases he or she has performed (see the questions section below).
• Know the physiotherapy plan before the operation: where it will take place and what its aims are.
• Agree with the team on a clear follow-up plan after you return.

Length of stay, date of air travel, number of physiotherapy sessions and the follow-up schedule

We do not set uniform figures for these, because the treating team determines them according to your condition, bone healing and the follow-up plan. We also found no scientific guidance specific to air travel after HTO; what is available concerns joint replacement and varies between surgeons, so ask your surgeon about the right timing for your case.

After returning to your country

• You will need clinical and radiographic follow-up to review bone healing, either remotely with the team that performed the operation or with a local orthopedic surgeon.
• Before leaving, make sure you carry: the operative report, a statement of the type of plate and screws used, the X-ray images, the weight-bearing and physiotherapy instructions, the recommendations on medication and clot prevention, and the way to contact the team.
• If worrying signs appear such as those mentioned in the complications section, seek urgent medical assessment in your own country and inform the team that performed the operation.

Important Questions to Ask Your Orthopedic Surgeon Before HTO

These questions are not a list of mandatory requirements, and there is no single standard that applies to everyone. They are ideas to help you discuss your case clearly with your surgeon, so choose from them what suits you.

About your condition and planning

1. Does my bowing originate in the tibia, the femur or both? And how did that affect your plan?
2. Which images did you rely on in analysing my axis? And what are my main measurements (such as MPTA, JLCA and the mechanical axis)?
3. How did you decide the correction target for my case, and why?
4. What is the condition of the outer part of my knee and the kneecap, and does it affect the suitability of HTO?
5. How do factors such as my weight, my smoking and my age affect your plan?
6. What other options are suitable for me (partial or total replacement, or non-surgical treatment), and why do you consider this option more or less suitable?
7. Do you see a need for an accompanying procedure (for the meniscus, the articular cartilage or the ligament), and on what basis?

About the technique and implants

8. What type of osteotomy do you propose for me, and why?
9. Will the bone gap need a graft or a substitute? And what would its source be?
10. What type of plate and screws will be used? And is the plate expected to be removed later? Under what circumstances?
11. Do you use navigation or patient-specific guides, and when do you consider them useful?
12. What do you do if a hinge fracture occurs during the operation?

About experience

13. How many HTO operations have you performed? And do you track your results (healing, the need for later replacement, complications)?

About recovery

14. What is your plan for putting weight on the leg, and why? And does it change if circumstances change?
15. What is the plan for clot prevention and physiotherapy, and where will it take place?
16. When will X-rays be taken, and how will you judge bone healing?

About travel, follow-up and cost

17. When can I fly, in your assessment of my case?
18. How long do you suggest I stay in Turkey, and what should be completed before I leave?
19. Who will follow me after I return, and how do I contact you if worrying signs appear? And what will I be given (the operative report, the type of plate, the images)?
20. What is included and not included in the financial offer? Is the hospital licensed and accredited as required? And who bears the cost of treating complications if they occur?

Medical note: this information is for general education. It does not replace consultation with a specialist doctor and is not a diagnosis or a prescription.