Senior Director, Joint Replacement Programme, BLK-Max Super Speciality Hospital, New Delhi
Part 4 of 9 in Diagnosis & Management of Degenerative Joint Disease
High Tibial Osteotomy and Partial Knee Replacement: Preserving the Joint Before Full Replacement
September 6, 2026
Between medical management and total joint replacement sits a middle tier of surgery that Dr. Ishwar Bohra urged the doctors on his masterclass call not to overlook: procedures that preserve the patient's own joint rather than replace it.
High tibial osteotomy: realigning rather than replacing
For patients with unicompartmental arthritis, meaning only one side of the knee is damaged, cutting and realigning the bone at the fibular head, a procedure known as high tibial osteotomy, transfers body weight back across the joint the way it was distributed before the arthritis developed. Dr. Bohra said this can halt the progression of arthritis for anywhere from five to fifteen years, depending on how advanced the disease already was at the time of surgery.
Partial knee replacement for one-sided disease
When alignment surgery is no longer enough but the disease is still confined to one compartment of the knee, partial knee replacement replaces only the damaged area rather than the whole joint. Dr. Bohra described it as a quick procedure, sometimes done as day care, after which patients return to activities such as ground sitting and swimming within a month.
A message about timing
Dr. Bohra was direct about why this matters for referring doctors specifically: a growing number of younger patients present with medial or lateral compartment arthritis while the rest of the joint is still healthy, and identifying them early, before the disease spreads across the whole knee, is what makes partial replacement possible instead of a full one. A patient who has this surgery, in his account, can resume even a physically demanding professional role within a week, become largely painfree, and return to something close to normal function, provided the referral happens while the disease is still confined to one side of the joint.
This guide is based on a live Jivo Masterclass: Dr. Ishwar Bohra taught doctors across Africa on April 27, 2025.
FROM THE LIVE Q&A
Dr. Olimei
What is the total cost of doing a total knee replacement, in dollars?
Dr. Ishwar Bohra
Approximate cost in my own practice runs around 7,000 to 7,500 US dollars, depending on the patient's room selection and other choices. India, and our hospital specifically, offers one of the most subsidised rates in the world compared with the West and the rest of Asia.
Frequently Asked Questions
Is there a relationship between vitamin D deficiency and osteoarthritis?▼
Definitely, because vitamin D is essential in bone metabolism: it regulates the calcium, magnesium and phosphorus that are the key minerals of bone strength. If vitamin D is low, the subchondral bone that gives cartilage its strength becomes weak, so the cartilage starts to wear and the bone becomes soft and malaligned, which leads to arthritis. This is a major contributory factor that often isn't picked up clinically, so once a patient is diagnosed with hypovitaminosis D, it should be corrected immediately to avoid future complications.
Is total knee replacement indicated for children with juvenile idiopathic arthritis?▼
Hip replacement can be done even after 13 to 14 years of age, but knee replacement has to wait until 18, because the longevity of implants in children is not very good and outcomes are worse than with hip replacement. If a child is severely affected, knee replacement can be considered after age 16 to 18; before that, an alternative non-replacement approach, such as bracing, is used to manage the pain.
Is there any risk of malignant transformation in a patient with a malunited tibia fracture of more than 10 years' duration without treatment?▼
No, a malunited fracture carries no risk of malignant transformation.
What is the total cost of doing a total knee replacement, in dollars?▼
Approximate cost in my own practice runs around 7,000 to 7,500 US dollars, depending on the patient's room selection and other choices. India, and our hospital specifically, offers one of the most subsidised rates in the world compared with the West and the rest of Asia.
What is high tibial osteotomy?▼
A procedure that cuts and realigns the bone at the fibular head to shift body weight back across a knee affected by one-sided arthritis, halting its progression for five to fifteen years depending on the stage at surgery.
When is partial knee replacement an option?▼
When arthritis is confined to one compartment of the knee. Only the damaged area is replaced, and recovery is fast, sometimes on a day-care basis.
How quickly can patients return to activity after partial knee replacement?▼
Dr. Bohra described patients resuming demanding professional duties within a week and activities such as ground sitting and swimming within a month.
Why does early referral matter for joint-preserving surgery?▼
High tibial osteotomy and partial knee replacement are only options while arthritis is confined to one part of the joint. Once it becomes diffuse, total replacement is the only remaining surgical option.
In This Series: Diagnosis & Management of Degenerative Joint Disease
- 1.Diagnosis and Management of Degenerative Joint Disease
- 2.Degenerative Joint Disease: Risk Factors and How to Diagnose It in Clinic
- 3.Managing Early Osteoarthritis Without Surgery: Lifestyle, Bracing and Medication
- 4.High Tibial Osteotomy and Partial Knee Replacement: Preserving the Joint Before Full Replacement
- 5.Total Knee Replacement for Advanced Osteoarthritis: Indications and Long-Term Survival
- 6.Robotic Joint Replacement: Closing the Gap Between a Working Knee and a Happy Patient
- 7.Complex and Infected Joint Replacement Cases: What a Revision Surgery Actually Involves
- 8.Beyond the Knee: Hip, Shoulder and Elbow Replacement in Degenerative Joint Disease
- 9.The Real Cost of Total Knee Replacement in India