High Tibial and Distal Femoral Osteotomy Rehabilitation Protocol


Prepare for surgery

Maximise lower limb strength (focus on VMO and gluteal complex)

Educate on post-operative rehabilitation; Fit and educate on use of crutches

Weeks 0-3

Soft Tissue







Weight Bearing Status







Swelling reduction & regular icing (20 min. every 2-3 hours)

Compression with short leg TED and double tubigrip to knee, regular rest and elevation, encourage calf and quads contractions

Hamstring, calf and ITB stretches

Touch Weight Bearing (20%) with crutches                    OR ___________


Static and inner range knee contractions (0-30°), calf pumps, hip coronal and sagittal resistance exercises


Active and passive ROM (0-90°)


Usually not required                                                        OR ____________

Weeks 3-6

Soft Tissue



Weight Bearing Status







Daily scar massage

Foam roller for ITB (not for DFVO), gluteals, calf and HS releases


Partial Weight Bearing (50%) with crutches                       OR ___________

Commence walking in water at chest level


Commence stationary bike, low resistance leg press (0-45°)

Employ biofeedback when appropriate


Gradual restoration of full active and passive ROM

Weeks 6-12

Weight Bearing Status











Progress to Full Weight Bearing (once x-rays confirm bone union progressing and cleared by surgeon)

Discard crutches over 2-3 week period once balance and gait pattern normalizes

Gait re-training aiming to optimize knee extension, heel strike and toe off


Progress to gym-focused program Leg press and squat (0-60°), calf raises, hip abduction, hip adduction, hip flexor, HS curls, stationary bike

Commence eccentric WB quads sets once strength improving eg step ups

Address significant deficits eg poor gluteal control, tight soft tissue structures, balance exercises

No open chain exercises or deep lunges


Freestyle swimming initially with pool buoy then progress to kicking

Weeks 12+





Progression of gym-based rehabilitation as above with increased resistance

Balance exercise to improve proprioception eg wobble board, mini tramp


Add elliptical trainer / stepper machine / rower machine

Swimming with flippers and road bike

Months 6+

Sports-specific activities

No running or return to sport unless cleared by surgeon Note: Return to sports highly dependent on severity of osteoarthritis

(03) 8640 0692

Call for an appointment

(03) 8595 1800