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Tibial Tubercle Osteotomy


What you need to know about tibial tubercle osteotomy (TTO):

TTO is surgery to place your patella (knee cap) in the correct position. Your surgeon will line your knee cap up with your thigh and shin. This may relieve pain and improve movement of your leg.

How to prepare for TTO:

  • Your healthcare provider will talk to you about how to prepare for surgery. You may need x-rays or a CT scan. This will help your healthcare provider plan for your surgery. Do not eat or drink anything after midnight on the day of your surgery. Your healthcare provider will tell you what medicines to take or not take on the day of your surgery. You may be given an antibiotic through your IV to help prevent a bacterial infection.
  • Arrange for someone to drive you home after your surgery. Do not drive yourself home.

What will happen during TTO:

  • You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given spinal anesthesia to numb the surgery area. With spinal anesthesia, you may still feel pressure or pushing during surgery, but you should not feel any pain.
  • Your healthcare provider will make an incision in your skin right under your knee cap. He will make a cut at the top of your shin bone. He will place your knee cap in the correct position. He may use hardware such as screws or a wire to hold your knee cap in place. He will close the incision with stitches and cover it with a bandage. You may also have a knee immobilizer on your leg to prevent movement.

What will happen after TTO:

You may need to wear your knee immobilizer at all times except when you are sleeping. You may be given crutches, a cane, or a walker to keep weight off of your leg. A physical therapist may teach you exercises to help improve movement and strength, and to decrease pain. He may also teach you how to use your crutches. You may receive a continuous passive motion machine (CPM). The CPM helps gently move your knee to prevent stiffness.

Risks of TTO:

Your incision may take longer to heal, or not heal correctly. Your shin bone may break during the surgery. Nerves, blood vessels, ligaments, or muscles may be damaged. Your joint may become stiff, numb, and more painful. Your joint movement may not be the same as it was before. You may need more surgery to remove the hardware placed in your shin bone. You may get an infection or bleed more than expected. You may get a blood clot in your leg. This may become life-threatening.

Call 911 for any of the following:

  • You feel lightheaded, short of breath, and have chest pain.
  • You cough up blood.
  • You have trouble breathing.

Seek care immediately if:

  • Your leg feels warm, tender, and painful. It may look swollen and red.
  • Blood soaks through your bandage.
  • Your stitches come apart.

Contact your healthcare provider if:

  • You have a fever or chills.
  • Your wound is red, swollen, or draining pus.
  • You have nausea or are vomiting.
  • Your skin is itchy, swollen, or you have a rash.
  • You have questions or concerns about your condition or care.


You may need any of the following:

  • Blood thinners help prevent blood clots. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take a blood thinner. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any other medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Take your blood thinner exactly as prescribed by your healthcare provider. Do not skip does or take less than prescribed. Tell your provider right away if you forget to take your blood thinner, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely.
  • Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Support devices:

You may be given crutches, a cane, or a walker to limit the weight on your leg. You may also need a continuous passive motion (CPM) machine. The CPM helps gently move your knee to prevent stiffness. Ask your healthcare provider for more information about any support devices you may need.

Physical therapy:

A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. He may also teach you how to use your crutches, cane, or walker.

Care for your wound as directed:

Your healthcare provider will tell you how to care for your incision wound. Watch for signs of an infection every time you change your bandage. Signs of infection may include swelling, redness, or pus draining from your wound. Keep your wound clean and dry. Change the bandage as directed and when it gets wet or dirty. Your healthcare provider will tell you when you can shower.


  • Do not put weight on your leg. Your leg needs to heal before you walk on it. You will need to use crutches, a cane, or a walker to keep weight off of your leg. Ask your healthcare provider when you can return to your normal daily activities.
  • Wear your knee immobilizer when you are out of bed. The immobilizer will prevent your knee cap from moving the wrong way and causing damage. You may remove the immobilizer when you sleep.
  • Apply ice on your knee cap. Do this for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
  • Apply heat on your knee cap. Do this for 20 to 30 minutes every 2 hours for as many days as directed. Heat helps decrease pain and muscle spasms.
  • Elevate your leg. You will need to keep your leg above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your leg on pillows or blankets to keep it elevated comfortably.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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