Long-term survival rate of closing wedge high tibial osteotomy with high valgus correction: a 15-year follow-up study



The influence of closing wedge high tibial osteotomy (CW-HTO) with high valgus correction on its survival is unclear. This study aimed to conduct a 15-year follow-up cohort study to estimate the long-term survival rate of CW-HTO. Factors related to poor outcomes were investigated.


A total of 159 knees in 123 patients were followed up, and 120 knees in 96 patients were enrolled for statistical analysis. Femorotibial angles were measured by standing anterior–posterior radiographs of the knee. Clinical objective evaluation was performed by the Japanese orthopaedic association (JOA) score of the knee, and scores lower than 70 points defined the poor result (PR) group. The survival rate of OW-HTO was estimated. Logistic regression analyses were performed to determine the risk factors for PR and conversion to total knee arthroplasty (TKA).


A total of 16 knees in 15 patients (13.3%) underwent TKA 14.0 ± 4.8 (4-20) years after CW-HTO. The 5-year survival rate was 99.2%, 10-year was 96.7%, 15-year was 92.5%, and 86.7% at final follow-up (17.9 years). Based on the JOA score, 44 patients (35.8%) belonged to the PR group, and their risk factors were obesity (p = 0.018), low femorotibial angle (p = 0.019), low JOA score (p = 0.040), low knee extension angle (p = 0.045), and low knee flexion angle (p = 0.046).


The 15-year survival rate of CW-HTO was 92.5%. While higher scores of objective outcomes were kept over long-term follow-up, the risk factors for a worsening score or TKA conversion were obesity and severity of preoperative knee symptoms.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  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 90:592–596

    CAS  Article  Google Scholar 

  2. 2.

    Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160

    Article  Google Scholar 

  3. 3.

    Argenson JN, Boisgard S, Parratte S, Descamps S, Bercovy M, Bonnevialle P et al (2013) Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: a multicenter French nationwide study including 846 cases. Orthop Traumatol Surg Res 99:385–390

    Article  Google Scholar 

  4. 4.

    Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E (2020) Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05890-0

    Article  PubMed  Google Scholar 

  5. 5.

    Campi S, Pandit HG, Dodd CAF, Murray DW (2017) Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 25:736–745

    CAS  Article  Google Scholar 

  6. 6.

    Chalmers BP, Limberg AK, Tibbo ME, Perry KI, Pagnano MW, Abdel MP (2019) Total knee arthroplasty after high tibial osteotomy results in excellent long-term survivorship and clinical outcomes. J Bone Joint Surg Am 101:970–978

    Article  Google Scholar 

  7. 7.

    Cheng X, Liu F, Xiong F, Huang Y, Paulus AC (2019) Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res 14:179

    Article  Google Scholar 

  8. 8.

    Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM et al (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 96:1425–1432

    CAS  Article  Google Scholar 

  9. 9.

    Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S et al (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46

    Article  Google Scholar 

  10. 10.

    Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12-28-year follow-up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96

    Article  Google Scholar 

  11. 11.

    Gøthesen O, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P et al (2013) Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994-2009. Bone Joint J 95:636–642

    Article  Google Scholar 

  12. 12.

    Gstöttner M, Pedross F, Liebensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128:111–115

    Article  Google Scholar 

  13. 13.

    Han JH, Yang JH, Bhandare NN, Suh DW, Lee JS, Chang YS et al (2016) Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 24:2567–2577

    Article  Google Scholar 

  14. 14.

    Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA (2014) The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J. 96-B:1491–1497

    CAS  Article  Google Scholar 

  15. 15.

    Ishimatsu T, Takeuchi R, Ishikawa H, Yamaguchi Y, Maeyama A, Osawa KJ et al (2019) Hybrid closed wedge high tibial osteotomy improves patellofemoral joint congruity compared with open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:1299–1309

    Article  Google Scholar 

  16. 16.

    Jackson JP, Waugh W, Green JP (1969) High tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 51:88–94

    CAS  PubMed  Google Scholar 

  17. 17.

    Javidan P, Adamson GJ, Miller JR, Durand P Jr, Dawson PA, Pink MM et al (2013) The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med 41:80–86

    Article  Google Scholar 

  18. 18.

    Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79

    Article  Google Scholar 

  19. 19.

    Kim JH, Kim HJ, Lee DH (2017) Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis. Sci Rep 7:7296

    Article  Google Scholar 

  20. 20.

    Koshino T, Tsuchiya K (1979) The effect of high tibial osteotomy on osteoarthritis of the knee: clinical and histological observations. Int Orthop 3:37–45

    Article  Google Scholar 

  21. 21.

    Majima T, Yasuda K, Katsuragi R, Kaneda K (2000) Progression of joint arthrosis 10 to 15 years after high tibial osteotomy. Clin Orthop Relat Res 381:177–184

    Article  Google Scholar 

  22. 22.

    Meehan JP, Danielsen B, Kim SH, Jamali AA, White RH (2014) Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty. J Bone Joint Surg Am 96:529–535

    Article  Google Scholar 

  23. 23.

    Mohammad HR, Strickland L, Hamilton TW, Murray DW (2018) Long-term outcomes of over 8,000 medial Oxford Phase 3 Unicompartmental Knees-a systematic review. Acta Orthop 89:101–107

    Article  Google Scholar 

  24. 24.

    Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year follow-up study. Clin Orthop Relat Res 367:18–27

    Article  Google Scholar 

  25. 25.

    Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR (2016) High tibial osteotomy: a systematic review and current concept. Arch Bone Jt Surg 4:204–212

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Sasaki T, Yagi T, Monji J, Yasuda K, Tsuge H (1986) High tibial osteotomy combined with anterior displacement of the tibial tubercle for osteoarthritis of the knee. Int Orthop 10:31–40

    CAS  PubMed  Google Scholar 

  27. 27.

    Schenke M, Dickschas J, Simon M, Strecker W (2018) Corrective osteotomies of the lower limb show a low intra- and perioperative complication rate-an analysis of 1003 patients. Knee Surg Sports Traumatol Arthrosc 26:1867–1872

    Article  Google Scholar 

  28. 28.

    Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D et al (2018) Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 46:1362–1370

    Article  Google Scholar 

  29. 29.

    Sun H, Zhou L, Li F, Duan J (2017) Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis. J Knee Surg 30:158–165

    Article  Google Scholar 

  30. 30.

    Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R (2015) Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 97:715–720

    Article  Google Scholar 

  31. 31.

    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 79:230–234

    Article  Google Scholar 

  32. 32.

    Wang Z, Zeng Y, She W, Luo X, Cai L (2018) Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials. Int J Surg 60:153–163

    Article  Google Scholar 

  33. 33.

    Wildner M, Peters A, Hellich J, Reichelt A (1992) Complications of high tibial osteotomy and internal fixation with staples. Arch Orthop Trauma Surg 111:210–212

    CAS  Article  Google Scholar 

  34. 34.

    Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195

    Google Scholar 

  35. 35.

    Yoon JR, Ko SN, Jung KY, Lee Y, Park JO, Shin YS (2019) Risk of revision following total knee arthroplasty or high tibial osteotomy: a nationwide propensity-score-matched study. J Bone Joint Surg Am 101:771–778

    Article  Google Scholar 

Download references


This study was not supported by any funding

Author information



Corresponding author

Correspondence to Eiji Sasaki.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

The study was conducted with the approval of the Ethics Committee of our institution.

Consent to participate

All participants gave their written informed consent.

Consent for publication

All of the co-authors agreed with publishing this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sasaki, E., Akimoto, H., Iio, K. et al. Long-term survival rate of closing wedge high tibial osteotomy with high valgus correction: a 15-year follow-up study. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-06128-9

Download citation


  • Closed wedge high tibial osteotomy
  • Survival rate
  • 15 years
  • JOA scores
  • Total knee arthroplasty conversion