Download High Tibial Osteotomy (HTO) & Distal Femoral Osteotomy (DFO) Rehabilitation Protocol

High Tibial Osteotomy (HTO) &

Distal Femoral Osteotomy (DFO) Protocol

Phase 1: Weeks 0-6

Goals: crutch/brace education, pain and swelling control, range of motion, glute/quad/hamstring activation. Progressive ROM > 120 by 6 weeks

 

CPM Machine

  • Start 0-30, progress 5 degrees per day as tolerated to 120 (4 hours per day, discontinue at 4 weeks post-op)

0-6 Weeks Post Op

  • Opening Wedge: Non-weight bearing x 6 weeks
  • Closing Wedge: Non-weight bearing x 2 weeks; may begin WB transition at week 3
  • No Biking
  • Pain/edema control, patella mobilizations if necessary
  • Quad Sets/Hamstring co-contractions at multiple angles
  • SLR in brace at 0° until quad can maintain knee locked
  • Heel slides/ extension hangs
  • Calf stretches
  • Ankle pumps +/- with leg elevation
  • May begin BFR after day 14

Phase 2: Weeks 6-12

 

Goals: normal gait without assistance, full range of motion, proprioception, strengthening starting with isometrics and progressing appropriately

Progress from 2 crutches to one crutch and then full weight bearing over 2 weeks

Weeks 6-12

  • 2-week WB progression- (one week on two crutches, one week on one crutch)
  • Discontinue brace
  • No impact activities
  • Baseline proprioceptive/balance re-education
  • Achieve full ROM, or maintain if already achieved
  • Begin closed chain strengthening, progress balance, core/pelvis and stability work
  • Patellar/tibial/femoral mobilization for terminal ROM
  • Stationary bike

 

 

Phase 3: Weeks 12-24

Goals: Continue and advance strengthening: lower chain concentric/eccentric strengthening of core/hips/glutes/quads/hamstrings, dynamic lower chain strengthening, progress non-impact cardio training, progress proprioception

 

Weeks 12-24

  • Non-impact cardio allowed after radiographic clearance by physician
  • Progress all strengthening as tolerated over months 3-6
  • No impact activities until 6 months

Phase 4: 6 Months +

 

  • No formal restrictions after radiographic clearance by physician
  • Progress back to impact activities if strength is appropriate
  • Return to sport progression as appropriate