High Tibial and Distal Femoral Osteotomy
Rehabilitation Protocol


mobility  icon

Prepare for surgery

  • black CheckmarkMaximize lower limb strength (focus on VMO and gluteal complex)
  • black CheckmarkEducate on post-operative rehabilitation
  • black CheckmarkFit and educate on use of crutches

Weeks 0-2

soft Tissue  icon

Soft Tissue

  • black CheckmarkSwelling reduction & regular icing (20 min. every 2-3 hours when awake)
  • black CheckmarkCompression with short leg TED and double tubigrip to knee, regular rest and elevation, encourage calf and quads contractions
  • black CheckmarkHamstring, calf and ITB stretches
weight  icon

Weight Bearing Status

  • black CheckmarkTouch Weight Bearing with crutches
mobility  icon


  • black CheckmarkStatic and inner range knee contractions (0-30°)
  • black CheckmarkCalf pumps, hip coronal and sagittal resistance exercises


  • white CheckmarkActive within the limit of ROM Brace


  • black CheckmarkROM Brace 0-30 degrees flexion

Weeks 2-6

soft Tissue  icon

Soft Tissue

  • black CheckmarkDaily scar massage
  • black CheckmarkFoam roller for ITB (not for DFVO), gluteals, calf and HS releases
weight  icon

Weight Bearing Status

  • black CheckmarkTouch Weight Bearing
mobility  icon


  • black CheckmarkActive strengthening within limits of Brace

ROM Brace

  • white CheckmarkIncrease by 10 degrees flexion per week

Weeks 6-12

weight icon

Weight Bearing Status

  • black CheckmarkPartial Weight Bearing
  • black CheckmarkBegin at 50% of body weight and increase by 10% per week
mobility  icon


  • black CheckmarkActive Quads, Hamstring, Gluteal strengthening


  • white CheckmarkIncrease as can tolerate


  • black CheckmarkWean out of ROM Brace

Weeks 12+

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Soft Tissue

  • black CheckmarkProgress to gym-focused program
  • black CheckmarkLeg press and squat (0-60°), calf raises, hip abduction, hip adduction, hip flexor, HS curls, stationary bike
  • black CheckmarkCommence eccentric WB quads sets once strength improving e.g. step ups
  • black CheckmarkAddress significant deficits e.g. poor gluteal control, tight soft tissue structures, balance exercises
  • black CheckmarkBalance exercise to improve proprioception e.g. wobble board, mini tramp
soft Tissue  icon


  • black CheckmarkAdd elliptical trainer / stepper machine / rower machine
  • black CheckmarkSwimming with flippers and road bike

6 months +

activities  icon

Sports-specific activities

  • black CheckmarkNo running or return to sport unless cleared by Dr Seeto
  • black CheckmarkReturn to sports highly dependent on severity of osteoarthritis
Knee background

Do you need a

Knee replacement?

Dr Seeto in affiliation with Medibank Private and East Sydney Private hospital, offers a program for eligible Medibank Private Members, to eliminate medical out of pocket costs for your Knee Replacement.

The program includes a pre-surgery preparation program, spending the minimal time necessary in hospital, as well as home rehabilitation if necessary.


Out Of Pocket

Knee operation

Book a consultation


Contact us