Survival and functional outcome of high tibial osteotomy for medial knee osteoarthritis: a 10–20-year cohort study

  • A. F. Y. van Wulfften PaltheEmail author
  • N. D. Clement
  • O. P. P. Temmerman
  • B. J. Burger
Original Article • KNEE - OSTEOTOMY



The primary aim of this study was to identify independent predictors of long-term survivorship after high tibial osteotomy (HTO). The secondary aims were to describe the functional outcome of surviving HTO 10–20 years after surgery.


A retrospective cohort of 223 HTO that were performed for the treatment of medial osteoarthritis was identified. Details were recorded from the patient notes. All surviving patients were contacted and asked to complete a Tegner Activity Scale, Lysholm Knee Score and rate pain using the Visual Analogue Scale (VAS). Survival analysis was performed, using conversion to arthroplasty as the definition of failure.


The mean age was 54 years (24–80 years). There were 123 (55.2%) in males and 100 (44.8%) in females. The mean BMI was 27.2 (SD 3.9). Twenty (9%) patients were lost to follow-up. The mean follow-up was 12 (SD 4) years. Survival at 10 years was 75 and 55% at 15 years and less than 40% at 20 years. Cox regression analysis demonstrated age of 50 years or more, female gender and surgical technique to be significant independent predictors of failure. The median Tegner score was 3 (inter-quartile range (IQR) 1–3). The mean Lysholm score was 75.5 (SD 18.4). The median VAS was 5 (IQR 0–6).


The medium- to long-term survival and functional outcome after HTO was good to excellent at 10–20 years of follow-up. Age, gender, surgeon and surgical technique were identified as independent predictors of failure.


Knee Tibia Arthritis Osteotomy Technique Survival 



The authors thank Rinse Meester and Floor Kappelhof for their assistance in collecting data for this study.


This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SMA, Verhaar JAN (2014) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 12:CD004019Google Scholar
  2. 2.
    Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160. CrossRefPubMedGoogle Scholar
  3. 3.
    Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotta 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
  4. 4.
    Lysholm J, Tegner Y (2007) Knee injury rating scales. Acta Orthop 78:445–453CrossRefPubMedGoogle Scholar
  5. 5.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49Google Scholar
  6. 6.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  7. 7.
    Murray DW, Carr AJ, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg Br 75:697–704CrossRefPubMedGoogle Scholar
  8. 8.
    Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA (2014) The outcome at 10 years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J 96-B:1491–1497CrossRefPubMedGoogle Scholar
  9. 9.
    Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2014) Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients. Int Orthop 38:55–60CrossRefPubMedGoogle Scholar
  10. 10.
    Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24:61–69CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) Survivorship of the high tibial valgus osteotomy. A 10-to-22-year followup study. Clin Orthop Relat Res 367:18–27CrossRefGoogle Scholar
  12. 12.
    Weale AE, Lee AS, MacEachern AG (2001) High tibial osteotomy using a dynamic axial external fixator. Clin Orthop Relat Res 382:154–167CrossRefGoogle Scholar
  13. 13.
    Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Südkamp 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
  14. 14.
    Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37:898–901CrossRefPubMedGoogle Scholar
  15. 15.
    Coventry MB (1973) Osteotomy about the knee for degenerative and rheumatoid arthritis: indications, operative technique, and results. J Bone Joint Surg 55-A:23CrossRefGoogle Scholar
  16. 16.
    Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 43B:746–751CrossRefGoogle Scholar
  17. 17.
    Chiang H, Hsu H, Jiang C (2006) Dome-shaped high tibial osteotomy: a long-term follow-up study. J Formos Med Assoc 105(3):214–219CrossRefPubMedGoogle Scholar
  18. 18.
    Fowler JL, Gie GA, MacEachern AG (1991) Upper tibial valgus osteotomy using dynamic external fixator. J Bone Joint Surg Br 73-B:690–691CrossRefGoogle Scholar
  19. 19.
    Magyar G, Toksvig-Larsen S, Lindstrand A (1998) Open wedge tibial osteotomy by callus distraction in gonarthrosis: operative technique and early results in 36 patients. Acta Orthop Scand 69:147–151CrossRefPubMedGoogle Scholar
  20. 20.
    Turi G, Cassini M, Tomasi PS, Armotti P, Lavini F (1987) Directional osteotomy of the knee using hemicallotasis. Chir Organi Mov 72:205–209PubMedGoogle Scholar
  21. 21.
    Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251Google Scholar
  22. 22.
    Mousa WFA (2014) Proximal tibial chevron osteotomy in treating adolescent tibia vara. Curr Orthop Pract 25(2):152–157CrossRefGoogle Scholar
  23. 23.
    Greene WB (1993) Infantile tibia vara. J Bone Joint Surg Am 75(1):130–143CrossRefPubMedGoogle Scholar
  24. 24.
    Duivenvoorden T, Brouwer R, Baan A, Bos P, Reijman M, Bierma-Zeinstra S (2014) Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 96(17):1425–1432CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • A. F. Y. van Wulfften Palthe
    • 1
    Email author
  • N. D. Clement
    • 2
  • O. P. P. Temmerman
    • 1
  • B. J. Burger
    • 1
  1. 1.Department of OrthopaedicsNoordwest ZiekenhuisgroepAlkmaarThe Netherlands
  2. 2.Department of Orthopaedics and TraumaThe Royal Infirmary of EdinburghEdinburghUK

Personalised recommendations