Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis

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.