Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 12, pp 3679–3686 | Cite as

Progression of medial compartmental osteoarthritis 2–8 years after lateral closing-wedge high tibial osteotomy

  • M. R. HuizingaEmail author
  • J. Gorter
  • A. Demmer
  • S. M. A. Bierma-Zeinstra
  • R. W. Brouwer



The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores.


This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren–Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated.


Mean follow-up was 5.2 ± 1.8 years (range 2–8.5). Mean preoperative mJSW was 3.4 ± 1.6 mm, which changed nonsignificantly (p = 0.51) to 3.4 ± 1.7 mm postoperatively. Mean annual joint space narrowing was 0.02 ± 0.34 mm/year. Progression to 1 KL grade or more was seen in 132 (44 %) patients, and annual risk of KL progression was 8.6 %. No KL progression was seen in 56 % of patients. Mean NRS decreased from 7.3 ± 1.5 to 3.5 ± 2.5 (p < 0.001). WOMAC scores decreased from 48.0 ± 17.2 to 23.6 ± 19.7 (p < 0.001). Failure was seen in 21 patients.


Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment.

Level of evidence



High tibial osteotomy Osteoarthritis Progression Failure Joint space 



We thank Inge Reininga for her input setting up this study and her suggestions for statistical analysis.

Author contributions

MH, JG, AD and RB contributed to the conception and design of this study. JG and AD performed data collection. MH and JG conducted data and statistical analysis. MH and JG drafted the manuscript, RB and SB contributed to critical revision. All authors approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare for this manuscript.


  1. 1.
    Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596CrossRefPubMedGoogle Scholar
  2. 2.
    Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205CrossRefPubMedGoogle Scholar
  3. 3.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840PubMedGoogle Scholar
  4. 4.
    Bito H, Takeuchi R, Kumagai K, Aratake M, Saito I, Hayashi R, Sasaki Y, Aota Y, Saito T (2009) A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 17:382–389CrossRefPubMedGoogle Scholar
  5. 5.
    Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Sudkamp N, Niemeyer P (2015) Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23:1949–1955CrossRefPubMedGoogle Scholar
  6. 6.
    Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, Castoldi F, Rossi R (2014) Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 42:690–698CrossRefPubMedGoogle Scholar
  7. 7.
    Breivik EK, Bjornsson GA, Skovlund E (2000) A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 16:22–28CrossRefPubMedGoogle Scholar
  8. 8.
    Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56:1204–1211CrossRefPubMedGoogle Scholar
  9. 9.
    Brouwer RW, Raaij van TM, Bierma-Zeinstra SM, Verhagen AP, Jakma TS, Verhaar JA (2007) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 18(3):CD004019Google Scholar
  10. 10.
    Brouwer RW, Bierma-Zeinstra S, van Raaij TM, Verhaar JAN (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 88:1454–1459CrossRefPubMedGoogle Scholar
  11. 11.
    Duivenvoorden T, van Diggele P, Reijman M, Bos PK, van Egmond J, Bierma-Zeinstra SM, Verhaar JA (2015) Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3644-2 PubMedPubMedCentralGoogle Scholar
  12. 12.
    Emrani PS, Katz JN, Kessler CL, Reichmann WM, Wright EA, McAlindon TE, Losina E (2008) Joint space narrowing and Kellgren-Lawrence progression in knee osteoarthritis: an analytic literature synthesis. Osteoarthr Cartil 16:873–882CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152:2399–2404CrossRefPubMedGoogle Scholar
  14. 14.
    Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S (2014) Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years’ follow-up. Knee 21:445–450CrossRefPubMedGoogle Scholar
  15. 15.
    Flecher X, Parratte S, Aubaniac J, Argenson JA (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96CrossRefPubMedGoogle Scholar
  16. 16.
    Ghomrawi HM, Mandl LA, Rutledge J, Alexiades MM, Mazumdar M (2011) Is there a role for expectation maximization imputation in addressing missing data in research using WOMAC questionnaire? Comparison to the standard mean approach and a tutorial. BMC Musculoskelet Disord 12:109. doi: 10.1186/1471-2474-12-109 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gstottner M, Pedross F, Liebensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128:111–115CrossRefPubMedGoogle Scholar
  18. 18.
    Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH, Jeong JH (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79CrossRefPubMedGoogle Scholar
  19. 19.
    Kaplan EL, Meier P (1958) Nonparametric Estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  20. 20.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Khoshbin A, Sheth U, Ogilvie-Harris D, Mahomed N, Jenkinson R, Gandhi R, Wasserstein D (2015) The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3849-4 Google Scholar
  22. 22.
    Kinds MB, Marijnissen AC, Vincken KL, Viergever MA, Drossaers-Bakker KW, Bijlsma JW, Bierma-Zeinstra SM, Welsing PM, Lafeber FP (2012) Evaluation of separate quantitative radiographic features adds to the prediction of incident radiographic osteoarthritis in individuals with recent onset of knee pain: 5-year follow-up in the CHECK cohort. Osteoarthr Cartil 20:548–556CrossRefPubMedGoogle Scholar
  23. 23.
    Kinds MB, Marijnissen ACA, Bijlsma JWJ, Boers M, Lafeber FPJG, Welsing PMJ (2013) Quantitative radiographic features of early knee osteoarthritis: development over 5 years and relationship with symptoms in the CHECK cohort. J Rheumatol 40:58–65CrossRefPubMedGoogle Scholar
  24. 24.
    Kohn L, Sauerschnig M, Iskansar S, Lorenz S, Meidinger G, Imhoff AB, Hinterwimmer S (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:146–151CrossRefPubMedGoogle Scholar
  25. 25.
    Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236CrossRefPubMedGoogle Scholar
  26. 26.
    Kroner AH, Berger CE, Kluger R, Oberhauser G, Bock P, Engel A (2007) Influence of high tibial osteotomy on bone marrow edema in the knee. Clin Orthop Relat Res 454:155–162CrossRefPubMedGoogle Scholar
  27. 27.
    Lequesne M (1995) Quantitative measurements of joint space during progression of osteoarthritis: chondrometry. In: Kuettner KE, Goldberg V (eds) Osteoarthritic disorders. American Academy of Orthopaedic Surgeons, Rosemont, pp 427–444Google Scholar
  28. 28.
    Marijnissen ACA, Vincken KL, Vos PAJM, Saris DBF, Viergever MA, Bijlsma JWJ, Bartels LW, Lafeber FPJG (2008) Knee Images Digital Analysis (KIDA): a novel method to quantify individual radiographic features of knee osteoarthritis in detail. Osteoarthr Cartil 16:234–243CrossRefPubMedGoogle Scholar
  29. 29.
    Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19:333–339CrossRefPubMedGoogle Scholar
  30. 30.
    Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP, Hirschmann MT (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23:2315–2323CrossRefPubMedGoogle Scholar
  31. 31.
    Myrnerts R (1980) High tibial osteotomy with overcorrection of varus malalignment in medial gonarthrosis. Acta Orthop Scand 51:557–560CrossRefPubMedGoogle Scholar
  32. 32.
    Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The install award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res 367:18–27CrossRefGoogle Scholar
  33. 33.
    Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26:1607–1616CrossRefPubMedGoogle Scholar
  34. 34.
    Odenbring S, Egund N, Lindstrand A, Lohmander LS, Willen H (1992) Cartilage regeneration after proximal tibial osteotomy for medial gonarthrosis. An arthroscopic, roentgenographic, and histologic study. Clin Orthop Relat Res 277:210–216Google Scholar
  35. 35.
    Okahashi K, Fujisawa Y, Sugimoto K, Tanaka Y (2010) Cartilage regeneration of knee OA after high tibial osteotomy. Tech Knee Surg 9:95–100CrossRefGoogle Scholar
  36. 36.
    Papachristou G (2004) Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg 124:288–297CrossRefPubMedGoogle Scholar
  37. 37.
    Pavelka K, Gatterova J, Altman RD (2000) Radiographic progression of knee osteoarthritis in a Czech cohort. Clin Exp Rheumatol 18:473–477PubMedGoogle Scholar
  38. 38.
    Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E (2011) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartil 19:1270–1285CrossRefPubMedGoogle Scholar
  39. 39.
    Ravaud P, Giraudeau B, Auleley GR, Drape JL, Rousselin B, Paolozzi L, Chastang C, Dougados M (1998) Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis. Ann Rheum Dis 57:624–629CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ravaud P, Auleley GR, Chastang C, Rousselin B, Paolozzi L, Amor B, Dougados M (1996) Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning. Br J Rheumatol 35:761–766CrossRefPubMedGoogle Scholar
  41. 41.
    Ravaud P, Giraudeau B, Auleley GR, Chastang C, Poiraudeau S, Ayral X, Dougados M (1996) Radiographic assessment of knee osteoarthritis: reproducibility and sensitivity to change. J Rheumatol 23:1756–1764PubMedGoogle Scholar
  42. 42.
    Saier T, Minzlaff P, Feucht MJ, Lammle L, Burghoff M, Ihle C, Imhoff AB, Hinterwimmer S (2015) Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3938-4 Google Scholar
  43. 43.
    Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19:122–127CrossRefPubMedGoogle Scholar
  44. 44.
    Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N, Torner J, Cooke TD, Hietpas J, Lynch J, Nevitt M (2010) Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 69:1940–1945CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195CrossRefPubMedGoogle Scholar
  46. 46.
    Spector TD, Cooper C (1993) Radiographic assessment of osteoarthritis in population studies: whither kellgren and lawrence? Osteoarthr Cartil 1:203–206CrossRefPubMedGoogle Scholar
  47. 47.
    Tang WC, Henderson IJ (2005) High tibial osteotomy: long term survival analysis and patients’ perspective. Knee 12:410–413CrossRefPubMedGoogle Scholar
  48. 48.
    Tetsworth K, Paley D (1994) Malalignment and degenerative arthropathy. Orthop Clin North Am 25:367–377PubMedGoogle Scholar
  49. 49.
    Thorstensson CA, Andersson ML, Jonsson H, Saxne T, Petersson IF (2009) Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis 68:1890–1893CrossRefPubMedGoogle Scholar
  50. 50.
    Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A (2006) Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:149–152CrossRefPubMedGoogle Scholar
  51. 51.
    van Raaij T, Reijman M, Brouwer RW, Jakma TS, Verhaar JN (2008) Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10–16 years. Acta Orthop 79:230–234CrossRefPubMedGoogle Scholar
  52. 52.
    Virolainen P, Aro HT (2004) High tibial osteotomy for the treatment of osteoarthritis of the knee: a review of the literature and a meta-analysis of follow-up studies. Arch Orthop Trauma Surg 124:258–261CrossRefPubMedGoogle Scholar
  53. 53.
    Ward RJ, Buckland-Wright JC (2008) Rates of medial tibiofemoral joint space narrowing in osteoarthritis studies consistent despite methodological differences. Osteoarthr Cartil 16:330–336CrossRefPubMedGoogle Scholar
  54. 54.
    Wiegant K, van Roermund PM, Intema F, Cotofana S, Eckstein F, Mastbergen SC, Lafeber FP (2013) Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthr Cartil 21:1660–1667CrossRefPubMedGoogle Scholar
  55. 55.
    Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M (2008) The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 67:1716–1723CrossRefPubMedGoogle Scholar
  56. 56.
    Ziegler R, Goebel L, Seidel R, Cucchiarini M, Pape D, Madry H (2015) Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part III: analysis of the microstructure of the subchondral bone and correlations with the articular cartilage and meniscus. Knee Surg Sports Traumatol Arthrosc 23:2704–2714CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • M. R. Huizinga
    • 1
    Email author
  • J. Gorter
    • 1
  • A. Demmer
    • 1
  • S. M. A. Bierma-Zeinstra
    • 2
  • R. W. Brouwer
    • 1
  1. 1.Department of Orthopaedic SurgeryMartini HospitalGroningenThe Netherlands
  2. 2.Department of Orthopaedics and General PracticeUniversity Medical Center Rotterdam, Erasmus Medical CenterRotterdamThe Netherlands

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