Abstract
The lateral closing and medial opening wedge high tibial osteotomy can correct a varus malalignment of the knee caused by medial compartment osteoarthritis. These procedures have produced great short-term and mid-term results. As no systematic review has examined their long-term results yet, the goal of this article was to compare the results of all articles about lateral closing and medial opening wedge high tibial osteotomies, published after the year 2000, with a mean follow-up of more than 10 years. A systematic search of the Medline, Web of Science and Cochrane databases resulted in the inclusion of 30 articles. All these studies combined examined the results of 7087 high tibial osteotomies in a total of 6636 patients after a mean follow-up of more than 10 years. Primary outcome measures were the survival rate of the osteotomy, functional scores, patient satisfaction and pain scores. Secondary outcome measures were alignment correction and the identification of factors influencing the survival of the osteotomy. The 5-year, 10-year, 15-year and 20-year survival rates, respectively, ranged from 86 to 100%, 64–97.6%, 44–93.2% and 46–85.1%. The subjective scoring systems showed an improvement postoperatively that was maintained until final follow-up. The anatomical and mechanical tibiofemoral axis were, respectively, corrected to a mean of 7.3°–13.8° of valgus and 0.6°–4° of valgus. The results of the articles evaluating the influence of potential risk factors were contradictory. Despite the low quality of the available evidence, the lateral closing and medial opening wedge high tibial osteotomy seem to remain valid long-term treatment options for patients with painful varus malalignment caused by isolated medial compartment osteoarthritis of the knee. The available results indicate that the need for arthroplasty could be delayed for more than 15 years in the majority of patients. However, higher-quality studies are needed to confirm these findings. As a systematic review is assigned a level of evidence equivalent to the lowest level of evidence used from the analyzed manuscripts, the level of evidence of this systematic review is IV.
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References
Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Jt Surg Br 90:592–596
Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160
Andriacchi TP (1994) Dynamics of knee malalignment. Orthop Clin North Am 25:395–403
Benzakour T, Hefti A, Lemseffer M, El Ahmadi JD, Bouyarmane H, Benzakour A (2010) High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up. Int Orthop 34:209–215
Berman AT, Bosacco SJ, Kirshner S, Avolio A Jr (1991) Factors influencing long-term results in high tibial osteotomy. Clin Orthop Relat Res 272:192–198
Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E (2020) Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05890-0
Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Sudkamp N et al (2015) Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23:1949–1955
Bruni D, Iacono F, Akkawi I, Gagliardi M, Zaffagnini S, Marcacci M (2013) Unicompartmental knee replacement: a historical overview. Joints 1:45–47
Choi HR, Hasegawa Y, Kondo S, Shimizu T, Ida K, Iwata H (2001) High tibial osteotomy for varus gonarthrosis: a 10- to 24-year follow-up study. J Orthop Sci 6:493–497
Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthr Cartil 5:39–47
Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. a preliminary report. J Bone Jt Surg Am 47:984–990
Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. a critical long-term study of eighty-seven cases. J Bone Jt Surg Am 75:196–201
Debeyre J, Patte D (1962) Value of corrective osteotomies in the treatment of certain knee diseases with axial deviation. Rev Rhum Mal Osteoartic 29:722–729
Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM et al (2014) Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Jt Surg Am 96:1425–1432
Duivenvoorden T, van Diggele P, Reijman M, Bos PK, van Egmond J, Bierma-Zeinstra SMA et al (2017) Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc 25:895–901
Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S et al (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46
Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman BN, Aliabadi P et al (1995) The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 38:1500–1505
Flamme CH, Ruhmann O, Schmolke S, Wichmann R (2003) Long-term outcome following high tibial osteotomy with tension bend principle. Arch Orthop Trauma Surg 123:12–16
Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96
Gstottner M, Pedross F, Liebensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128:111–115
Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N, Malizos KN (2018) Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 26:3199–3205
Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8:103–110
Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. a ten to thirteen-year follow-up study. J Bone Jt Surg Am 69:332–354
Hernigou P, Roussignol X, Flouzat-Lachaniette CH, Filippini P, Guissou I, Poignard A (2010) Opening wedge tibial osteotomy for large varus deformity with Ceraver resorbable beta tricalcium phosphate wedges. Int Orthop 34:191–199
Huang TL, Tseng KF, Chen WM, Lin RM, Wu JJ, Chen TH (2005) Preoperative tibiofemoral angle predicts survival of proximal tibia osteotomy. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000149818.70975.07188-195
Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM et al (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39:64–70
Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Jt Surg Am 66:1040–1048
Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236
Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444
Kuwashima U, Okazaki K, Iwasaki K, Akasaki Y, Kawamura H, Mizu-Uchi H et al (2019) Patient reported outcomes after high tibial osteotomy show comparable results at different ages in the mid-term to long-term follow-up. J Orthop Sci 24:855–860
Liu JN, Agarwalla A, Gomoll AH (2019) High tibial osteotomy and medial meniscus transplant. Clin Sports Med 38:401–416
Majima T, Yasuda K, Katsuragi R, Kaneda K (2000) Progression of joint arthrosis 10 to 15 years after high tibial osteotomy. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200012000-00021177-184
Morrison JB (1970) The mechanics of the knee joint in relation to normal walking. J Biomech 3:51–61
Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The install award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res 367:18–27
Niinimaki TT, Eskelinen A, Mann BS, Junnila M, Ohtonen P, Leppilahti J (2012) Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee: finnish registry-based study of 3195 knees. J Bone Jt Surg Br 94:1517–1521
Omori G, Koga Y, Miyao M, Takemae T, Sato T, Yamagiwa H (2008) High tibial osteotomy using two threaded pins and figure-of-eight wiring fixation for medial knee osteoarthritis: 14 to 24 years follow-up results. J Orthop Sci 13:39–45
Oswald MH, Jakob RP, Schneider E, Hoogewoud HM (1993) Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty. J Arthroplasty 8:419–426
Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:403–408
Pfahler M, Lutz C, Anetzberger H, Maier M, Hausdorf J, Pellengahr C et al (2003) Long-term results of high tibial osteotomy for medial osteoarthritis of the knee. Acta Chir Belg 103:603–606
Polat G, Balci HI, Cakmak MF, Demirel M, Sen C, Asik M (2017) Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. J Orthop Surg Res 12:44
Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb(R) wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156
Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19:122–127
Schuster P, Gesslein M, Schlumberger M, Mayer P, Mayr R, Oremek D et al (2018) Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 46:1362–1370
Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N et al (2010) Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 69:1940–1945
Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368
Song SJ, Bae DK, Kim KI, Park CH (2019) Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics. Knee Surg Sports Traumatol Arthrosc 27:1310–1319
Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthr Cartil 14:190–195
Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Jt Surg Am 85:469–474
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919
Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A (2006) Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:149–152
van Raaij T, Reijman M, Brouwer RW, Jakma TS, Verhaar JN (2008) Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10–16 years. Acta Orthop 79:230–234
van Wulfften Palthe AFY, Clement ND, Temmerman OPP, Burger BJ (2018) Survival and functional outcome of high tibial osteotomy for medial knee osteoarthritis: a 10–20-year cohort study. Eur J Orthop Surg Traumatol 28:1381–1389
W-Dahl A, Robertsson O, Lohmander LS (2012) High tibial osteotomy in Sweden, 1998–2007: a population-based study of the use and rate of revision to knee arthroplasty. Acta Orthop 83:244–248
Wang Z, Zeng Y, She W, Luo X, Cai L (2018) Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials. Int J Surg 60:153–163
Webb M, Dewan V, Elson D (2018) Functional results following high tibial osteotomy: a review of the literature. Eur J Orthop Surg Traumatol 28:555–563
Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH (2013) Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy 29:2020–2028
Wright J, Heck D, Hawker G, Dittus R, Freund D, Joyce D et al (1995) Rates of tibial osteotomies in Canada and the United States. Clin Orthop Relat Res 319:266–275
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Ollivier, B., Berger, P., Depuydt, C. et al. Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sports Traumatol Arthrosc 29, 3569–3584 (2021). https://doi.org/10.1007/s00167-020-06262-4
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DOI: https://doi.org/10.1007/s00167-020-06262-4