High tibial osteotomy for the treatment of osteoarthritis of the knee: a review of the literature and a meta-analysis of follow-up studies.

Abstract

Proximal tibial osteotomy produces satisfactory early results, but these good results deteriorate with time. A meta-analysis, a set of statistical procedures designed to accumulate experimental and correlational results across independent studies, was undertaken to determine the final outcome of high tibial osteotomy of the knee. Following a comprehensive literature search from 1970 through 1998, the data of 19 relevant published studies were analysed in three separate arms. High tibial osteotomy had an averaged probability of a good or excellent result in 75.3% of the patients after 60 months and 60.3% after 100 months. The overall failure rate, including re-osteotomies, arthroplasties, meniscectomies, ligament reconstructions, infections and non-unions, was 24.6% at 10 years. The probability for total knee arthroplasty was 0.034 before 24 months, 0.078 between 24 and 47 months, and 0.114 between 48 and 71 months. The meta-analysis showed that high tibial osteotomy has an averaged probability of a good result in 60.3% of patients even after 100 months. Unchanged and mild pain was considered an unsatisfactory result. Knowing the natural cause of the disease, it is likely that most of these patients also gained from their operation to some extent, although the outcome was not as good as expected. However, we believe that there is a role for closed tibial osteotomy, as an alternative to total knee arthroplasty, only in carefully selected young patients.