Closing Verses Opening Wedge High Tibial Osteotomy: an Evidence-Based Review

Knee osteoarthritis is a common and disabling disorder made worse by lower extremity malalignment [3]. Medial knee arthrosis is the most common indication for high tibial osteotomy (HTO). Surgical techniques include closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, progressive callus distraction, and chevron osteotomy [4, 7]. Opening and closing wedge osteotomies are the most common. While lateral closing wedge HTO was once considered standard of care, both techniques have advantages and disadvantages, and neither has proven clinical superiority [3]. Technique selection, therefore, is largely driven by surgeon preference. Jackson [4] first described the closing wedge technique in the 1960s and demonstrated improvements in patient function and pain. This technique, however, is associated with fibular osteotomy or proximal tibiofibular joint release, possible peroneal nerve injury, longer rehabilitation, and a more challenging conversion to total knee arthroplasty [1, 6, 9]. Disadvantages of medial opening wedge osteotomy, on the other hand, include the possible need for bone graft, higher rates of nonunion, and the risk of collapse [9]. Reviewed here, Duivenvoorden’s article describes the mid-term follow-up on 92 patients randomized to high tibial opening wedge or closing wedge osteotomy for varus deformity and medial compartment OA. They investigated clinical and radiographic outcomes, in addition to survival rate, at a mean of 7 years postoperatively. The specific aims of this review are to (1) interpret this study’s findings and (2) to evaluate the validity of the authors’ conclusions and recommendations.