Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis

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.

Functional results following high tibial osteotomy: a review of the literature

“…Five studies used Lysholm and showed no difference. Range of movement was reportedly better in the opening wedge HTO group; however, a large sample from one paper may have influenced this [ 32 ]. Although this is a meta-analysis which in theory provides more robust analysis of the data, a major limitation in this review is that the studies included had a variety of PROMs used with differing methodology.…”

The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates

“…Plates with angularly stable ‘locking’ screws are generally used to ensure the osteotomy angle is maintained, since conventional screws have been shown to subside after the operation. 6,7 Opening wedge HTO procedures are more popular 8 due to the simpler surgical approach, lower risk of peroneal nerve damage, 9,10 and better postoperative flexion scores. 10 Unfortunately, the overall complication rate is still relatively high at 31%.…”

Patella Height Changes Post High Tibial Osteotomy

“…Many studies have compared the incidence of patella height changes between open wedge HTO and close wedge HTO. 15 Patellar baja frequently happen with open wedge osteotomies, 12 20 compared to a high degree of patella elevation produced with closing wedge osteotomies. 21 This traditionally described medial opening wedge HTO is always cut proximal to the tibial tuberosity or with a corona cut exiting just behind the patella tendon.…”

“…Among those that have been described were joint-line elevation, increase TS, patellar ligament shortening due to scaring or immobilization, and magnitude of angle of correction. 16 20 21 22 23 24 25 26 27 28 Hence with a fair number of 106 knees, we carried out a retrospective study to look at the possible factors that affect the change in patella height. We utilized the CDI as it was proven to have better reproducibility, and is also a more direct method to measure patella height compared to Insall-Salvati ratio which measures the patella tendon length.…”