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Jung SJ, Kang JH, Rhee SJ, Moon SW, Wang L, D’Lima DD. Difference in Correction Power between Hybrid Lateral Closed-Wedge High Tibial Osteotomy and Medial Open-Wedge High Tibial Osteotomy was Associated with Severity of Varus Deformity and Different Hinge Distance from Center of Deformity. Diagnostics (Basel) 2024; 14:1137. [PMID: 38893663 PMCID: PMC11171834 DOI: 10.3390/diagnostics14111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Hybrid lateral closed-wedge high tibial osteotomy (HBHTO) carries certain advantages over medial open-wedge high tibial osteotomy (OWHTO). We investigated the potential difference in the required correction angle between HBHTO and OWHTO to achieve an equal amount of whole lower-extremity alignment correction, retrospectively analyzing the preoperative plain radiographic images of 100 patients. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical lateral distal femoral angle (mLDFA), hip-knee-ankle axis (HKA), length of the tibia, width of the tibial plateau, length of the lower limb (leg length), and location of the center of deformity (CD) were measured. Differences in the required correction angle at the hinge point between the two techniques (CAD) were compared, and correlation analysis was performed to reveal the influential factors. The mean difference in CAD between HBHTO and OWHTO was 0.78 ± 0.22 (0.4~1.5)°, and mean WBL position change per correction angle was 3.9 ± 0.3 (3.0~4.6)% in HBHTO and 4.1 ± 0.3 (3.1~4.7)% in OWHTO. Correlation analysis revealed a strong positive correlation between CAD and HKA. mLDFA, JLCA, MPTA, leg length, OWCD, HBCD, and HCD were also significantly correlated with CAD. HBHTO required a 5.6% larger correction angle at the hinge point to achieve the same amount of alignment correction as OWHTO.
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Affiliation(s)
- Seok Jin Jung
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Jun Ho Kang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Sang Won Moon
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Republic of Korea
| | - Lih Wang
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
| | - Darryl D D’Lima
- Department of Molecular Medicine, Scripps Research, La Jolla, CA 92037, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, La Jolla, CA 92121, USA
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Harris C, Nadeem F, Hargreaves M, Campbell C, Momaya A, Casp A. Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:666-677. [PMID: 38410034 DOI: 10.1002/ksa.12084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty. METHODS Medline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including 'obesity', 'BMI', 'osteotomy' and 'high tibial osteotomy (HTO)' were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient-reported satisfaction scores and postoperative complications. RESULTS Nine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening-wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.). CONCLUSION Obesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chandler Harris
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Fahad Nadeem
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Mathew Hargreaves
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Collier Campbell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amit Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aaron Casp
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Constantin H, Salmon LJ, Russell V, Sundaraj K, Roe JP, Pinczewski LA. 20-Year Outcomes of High Tibial Osteotomy: Determinants of Survival and Functional Outcome. Am J Sports Med 2024; 52:344-351. [PMID: 38243788 DOI: 10.1177/03635465231217742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a successful joint-preserving procedure for the treatment of medial compartment osteoarthritis. Long-term survivorship of HTO ranges from 40% to 85%. There are consistent factors that predict failure. PURPOSE To determine the 20-year survival of HTO and identify predictors of failure. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 100 consecutive patients with medial bone-on-bone arthritis were prospectively studied to provide long-term patient-reported outcome measures after lateral closing-wedge HTO and determine the time to failure. Failure was defined as conversion to arthroplasty (total knee arthroplasty or unicompartmental knee arthroplasty) or revision HTO. RESULTS At 20 years, HTO survival was determined in 95 patients, and 5 were lost to follow-up. The overall survivorship of HTO at 20 years was 44%. The significant factors that were associated with better survivorship were age <55 years, body mass index <30, and Western Ontario and McMaster Universities Osteoarthritis Index pain score >45. These factors were used to define the favorable candidates. In the favorable candidates, survivorship was 100% at 5 years, after which there was a gradual decline to 62% survival at 20 years. Of those with HTO survival, 32 of 33 (97%) reported satisfaction with surgery, with a mean Knee injury and Osteoarthritis Outcome Score Pain score of 91 and Activities of Daily Living score of 97. CONCLUSION HTO is a successful surgical option to treat medial compartment osteoarthritis and prevent the need for arthroplasty in young patients. The most suitable candidates for HTO are aged <55 years, are not obese, and have not progressed to severe symptomatic disability.
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Affiliation(s)
- Harry Constantin
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | | | - Keran Sundaraj
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
| | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Leo A Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
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Lee SS, Lee YK, Kim IS, Ryu DJ, Jung EY, Lee DK, Wang JH. Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2022; 10:23259671221119152. [PMID: 36062158 PMCID: PMC9434689 DOI: 10.1177/23259671221119152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Time-dependent changes in lower extremity alignment after an opening-wedge
high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few
studies have investigated risk factors of postoperative alignment
change. Purposes: To investigate time-dependent alignment changes and identify predictive
factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and
September 2018. A total of 142 knees with a mean follow-up of 42 months were
included and classified as the change group when the amount of
hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the
no-change group. HKA angle was obtained at 6 time points: preoperatively and
at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively.
Multiple regression analysis was performed to identify the factors that were
correlated with the changes in the HKA angle from 3 months to the final
follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall
postoperative HKA angles progressed serially toward varus after OWHTO. The
mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and
–2.7°, respectively. The mean HKA angles of the change and no-change groups
were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°,
–3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was
predicted by preoperatively greater valgus stress joint line convergence
angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean
follow-up of 42 months. The overall postoperative HKA angles progressed
serially to varus angles after OWHTO. Preoperative greater valgus stress
joint line convergence angles and less medial joint space width were
predictive factors for greater change in alignment toward varus after
OWHTO.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Republic of Korea
| | - Young Keun Lee
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangjusi, Gyeonggido, Republic of Korea
| | - Il Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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Shen G, Shen D, Fang Y, Li X, Cui L, Wei B, Wu L. Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Surg 2022; 14:1549-1557. [PMID: 35611758 PMCID: PMC9363736 DOI: 10.1111/os.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022] Open
Abstract
As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.
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Affiliation(s)
- Gaobo Shen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Danhong Shen
- Nanjing University of Science and Technology, Nanjing, China
| | - Yuan Fang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuefei Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Longkang Cui
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing Wei
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lianguo Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Suh DW, Han SB, Yeo WJ, Cheong K, So SY, Kyung BS. Human umbilical cord-blood-derived mesenchymal stem cell can improve the clinical outcome and Joint space width after high tibial osteotomy. Knee 2021; 33:31-37. [PMID: 34536766 DOI: 10.1016/j.knee.2021.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/30/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited study about the human umbilical cord-blood derived mesenchymal stem cell (hUCB-MSC) cartilage regeneration procedures combined with high tibial osteotomy (HTO). We compared the clinical and radiological results of hUCB-MSC cartilage regeneration procedures combined with HTO to those of microfracture with HTO. METHODS From August 2017 to December 2018, HTO patients with International Cartilage Regeneration and Joint Preservation Society (ICRS) grade IV cartilage defects over 200 mm2 on medial femoral condyle (MFC) were enrolled. For comparison, all participants were divided into two groups: those who had undergone an hUCB-MSC induced cartilage regeneration procedure (group MSC) and those with microfractures only (group C, controls). Clinically, Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), and Lysholm scores were evaluated post-operatively at 18 months. Radiologically, mechanical axis (MA) and joint space width (JSW) were evaluated. RESULTS A total of 100 knees were enrolled (43 in group MSC, 57 in group C). The IKDC score in group MSC (69) was better than that in group C (62; P < 0.05). The JSW increment in the MSC group (0.6 mm) was more than that in group C (0.1 mm; P < 0.05). No patient developed nonunion, correction loss, or arthroplasty conversion. CONCLUSION hUCB-MSCs can improve clinical outcome and JSW better than microfracture only in HTO patients.
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Affiliation(s)
- Dong Won Suh
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Seung Beom Han
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Woo Jin Yeo
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Kuhoang Cheong
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Sang-Yeon So
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Bong Soo Kyung
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea.
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Increased joint obliquity after open-wedge high tibial osteotomy induces pain in the lateral compartment: a comparative analysis of the minimum 4-year follow-up outcomes using propensity score matching. Knee Surg Sports Traumatol Arthrosc 2021; 29:3495-3502. [PMID: 33151363 DOI: 10.1007/s00167-020-06342-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the effects of increased medial proximal tibial angle (MPTA) on the clinical outcomes and cartilage deterioration in the lateral compartment after a mean follow-up period of 4 years following open-wedge high tibial osteotomy (OWHTO) using propensity score matching (PSM) analysis. METHODS Among 376 knees treated with OWHTO for medial unicompartmental osteoarthritis with varus deformity, 36 knees with MPTA increase of > 95° and 108 knees with MPTA increase of < 95° at the final follow-up were included. The baseline prognostic factors [age, sex, preoperative hip-knee-ankle (HKA) angle, body mass index, and preoperative knee range of motion] were equalized between the 2 groups using PSM; consequently, 31 pairs of patients were compared. The radiographic and clinical outcomes, including lateral compartment pain, were assessed. For 18 patients in each group, second-look arthroscopy and cartilage status assessment were performed. RESULTS The preoperative demographics were similar between the groups. At the final follow-up, the HKA angle and joint line obliquity were significantly higher in the increased MPTA group. No significant differences were observed in the clinical outcomes between the groups. On second-look arthroscopy, significant cartilage deterioration of the lateral compartment was not observed in either group. Pain in the lateral compartment was experienced significantly more frequently in the increased MPTA group (p < 0.01). CONCLUSION Although excessively increased MPTA after HTO had no significant effects on the clinical outcomes and cartilage deterioration in the lateral compartment at the minimum 4-year follow-up, lateral compartment pain was experienced significantly more frequently in the increased MPTA group.
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Rodriguez-Merchan EC, Kachooei AR. Is There any Difference in the Survival of Conversion TKA After Previous HTO In Compare to Previous UKA? Factors to be Considered When Offering a Surgery. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:368-370. [PMID: 34423082 DOI: 10.22038/abjs.2020.52131.2575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Amir R Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Rothman Institute, Thomas Jefferson University, Philadelphia, USA
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Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement. J Clin Med 2021; 10:jcm10132743. [PMID: 34206331 PMCID: PMC8267674 DOI: 10.3390/jcm10132743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA ≤ 180°, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24-180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7° (SD 4.9) in group 1 and 179.5° (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 ± 15.9) and group 2 (84.3 ± 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA ≤ 180° (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study.
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