The High Tibial Osteotomy Personality Screen — Does This Survivorship Sound Good or Bad?

One of the best case series I've ever read, and the findings are reliable and practical

What’s the Claim?

A remarkable 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 looked at factors associated with revision and crafted a profile of the “favorable”" osteotomy candidate at the time of surgery:

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

These patients had 91% 10-year survivorship and 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?