Abstract
High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient.
Highlights
Knee osteoarthritis (OA) is a common and multi-factorial arthritic disorder, which may lead to joint dysfunction, i.e. reduction of joint motion and physical disability, as a result of degeneration, destruction, and loss of articular cartilage of knee joint [1]
After excluding 487 studies for reasons specified in Fig 1 and S1 Fig, a total of 22 studies (7 RCTs and 15 non-RCTs) encompassing 2582 cases, including 1274 knees which were underwent opening-wedge high tibial osteotomy (HTO) and 1308 ones with closing-wedge HTO operation, were enrolled in the final meta-analysis [5,6,7,8, 10, 15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]
As for clinical outcomes, the following several aspects were compared between opening-wedge and closing-wedge HTO, i.e. surgery time, duration of hospital stays, HSS knee score (> 1 year follow-up), knee pain VAS, range of motion and Lysholm knee score
Summary
Knee osteoarthritis (OA) is a common and multi-factorial arthritic disorder, which may lead to joint dysfunction, i.e. reduction of joint motion and physical disability, as a result of degeneration, destruction, and loss of articular cartilage of knee joint [1]. Most patients with knee OA would develop varus deformity, and varus malalignment further overloads the medial tibiofemoral compartment, causing degenerative changes in the articular cartilage at last. Opening-wedge and closing-wedge HTO conservative methods and surgical treatment were used for treatment of pain and dysfunction in knee OA. Surgical treatment included various techniques, i.e. high tibial osteotomy (HTO), arthroscopic surgery and total knee arthroplasty. HTO is the most frequently used method in young and more active patients [2]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call