High tibial osteotomy with articular cartilage surgery shows good early outcomes

Patients with knee osteoarthritis and medial compartment chondral pathology, varus malalignment or meniscal deficiency who underwent isolated tibial osteotomy with or without articular cartilage surgery and meniscal allograft transplantation have good early outcomes that diminish up to 10 years later, according to results of this study.

Researchers included 69 studies for a total of 4,557 patients in their systematic review of several databases. Average patient age was 53 years with an average follow-up of 7.1 years. The primary outcome measure was the modified Coleman Methodology Score.

The investigators found survival of isolated high tibial osteotomy (HTO) was 92.4% at 5-year follow-up. In addition, survival of isolated HTO was 84.5%, 77.3% and 72.3% at the 10-year, 15-year and 20-year follow-up, respectively.

At 5-year follow-up, HTO with articular cartilage surgery showed better survival at 97.7% than isolated HTO (92.4%) or HTO with meniscal allograft transplant (MAT) (90.9%). All patients who underwent isolated HTO, HTO with articular cartilage surgery or HTO with MAT showed improved clinical outcome scores. Survivorship of HTO was greater with an opening wedge technique at 98.7% than a closing wedge technique at 96.7%. However, there was no difference in HTO with articular cartilage surgery or with or without MAT at follow-up.

“Isolated HTO was successful and reliable surgery with excellent short- and mid-term survival and outcomes that deteriorated with longer-term follow-up (up to 20 years). HTO with concomitant procedures also demonstrated excellent early survival and clinical outcomes that deteriorated with time (up to 10 years),” the authors wrote in their study.