ICYMI: Likelihood of Long-term Joint Preservation with High Tibial Osteotomy

Sharing these survivorship figures will help inform what are some of our toughest in-office conversations

Editor’s Note: A version of this post was sent to our Joint Replacement subscribers. CORRelations’ advisor in Arthroscopy/Sports, Brian Gilmer MD, felt it too important for our sports medicine readership to miss, so we’ve modified the coverage a bit for the sports readership. — SSL

What’s the Claim?

A well-done, well-reported prospective, observational series of one surgeon’s lateral closing-wedge high tibial osteotomies — with 95 of 100 patients accounted for at a minimum of 20 years (!) — found survivorship after HTO, free from repeat osteotomy or arthroplasty, was 77% at 10 years and 44% at 20 years.

The authors then identified factors associated with revision and crafted a profile of the “favorable” osteotomy candidate at the time of surgery:

  • Younger than 55 years
  • A BMI < 30
  • A WOMAC pain score ≥ 45 points (they normalized the 20-point WOMAC pain subscore to a 100-point scale; higher values represent more-severe pain)

Patients categorized as “favorable” using those criteria had a 91% 10-year survivorship and a 62% 20-year survivorship.

The authors also did a great job of getting PROM scores on nearly all of their patients; among those who had not undergone conversion to TKA, the pain scores were really quite good and did not worsen between 10 and 20 years (for example, the mean WOMAC score was 85 out of 100 at 20 years).

How’s It Stack Up?