Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics

  • Sang Jun Song
  • Dae Kyung Bae
  • Kang Il Kim
  • Cheol Hee ParkEmail author



Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing unicompartmental knee arthroplasty (UKA) in patients with similar demographics.


Sixty HTOs and 50 UKAs completed between 1992 and 1998 were retrospectively reviewed. There were no significant differences in pre-operative demographics. The mean follow-up period was 10.7 ± 5.7 years for HTO and 12.0 ± 7.1 years for UKA (n.s.). The Knee Society knee and function scores, WOMAC, and range of motion (ROM) were investigated. The mechanical axis and femorotibial angle were evaluated. Kaplan–Meier survival analysis was performed (failure: revision to TKA) and the failure modes were investigated.


Most of the clinical and radiographic results were not different at the last follow-up, except ROM; ROM was 135.3° ± 12.3° in HTO and 126.8° ± 13.3° in UKA (p = 0.005). The 5-, 10-, 15-, and 20-year survival rates were 100%, 91.0%, 63.4%, and 48.3% for closed-wedge HTO, respectively, and 90.5%, 87.1%, 70.8%, and 66.4% for UKA (n.s.). The survival rate was higher than that for UKA until 12 years post-operatively but was higher in UKAs thereafter, following a remarkable decrease in HTO. The most common failure mode was degenerative osteoarthritic progression of medial compartment in HTO and femoral component loosening in UKA.


Long-term survival did not differ significantly between closed-wedge HTO and fixed-bearing UKA in patients with similar pre-operative demographics and knee conditions. The difference in post-operative ROM and failure mode should be considered when selecting a procedure.

Level of evidence



Knee Osteoarthritis Osteotomy Unicompartmental arthroplasty Survival 



No external funding was used.

Compliance with ethical standards

Conflict of interest

No benefits in any form were received or will be received from any commercial party related directly or indirectly to the subject of this article.

Ethical approval

All procecures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of our hospital.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, College of MedicineKyung Hee UniversitySeoulSouth Korea
  2. 2.Department of Orthopaedic SurgerySeoul Sacred Heart General HospitalSeoulSouth Korea
  3. 3.Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulSouth Korea

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