Impact of the Opening-Wedge and Closing-Wedge High Tibial Osteotomy on Clinical Outcomes of Total Knee Arthroplasty: A Systematic Review of Comparative Clinical Studies

Articles in Press

Document Type : SYSTEMATIC REVIEW

Authors

1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 mashad university of medical sciences

3 Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

4 Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Torbat Jam Faculty of Medical Sciences, Torbat Jam

6 Ghaem Hospital Orthopedic Research Center, Mashhad University of Medical Science

10.22038/abjs.2026.95154.4275

Abstract

Objectives: Eventually, all cases of closing wedge high tibial osteotomy (CW-HTO) and opening wedge HTO (OW-HTO) lead to failure, requiring a total knee arthroplasty (TKA) which is known as one of the most successful orthopedic surgeries. This systematic review aimed at answering this question: What are the outcomes of TKA following CW-HTO and OW-HTO?

Methods: The main databases were searched up to November 2025. Only studies that included both comparative arms of CW-HTO and OW-HTO were considered for further assessment. Main outcomes consisted of knee joint function scores such as international knee society (IKS) score and knee society score (KSS) was assessed. The meta-analysis was not feasible due to diversity in the data provided and follow-ups. The JBI quality assessment tool was used for assessing methodological quality for each study.

Results: From 6756 records identified and screened, three comparative clinical studies with a total of 541 TKA cases were included in this systematic review study. Two studies indicated no difference regarding KSS, and range of motion after TKA between CW-HTO and OW-HTO. However, one study reported improvements in walking ability after 80 to 90 months of follow-up for both groups. The most frequent complications were skin necrosis, joint stiffness, infection, peroneal nerve injury and posterior tibial nerve injury.

Conclusion: The limited amount of available evidence prevents definitive conclusions. Existing data indicate potential benefits, such as quicker relief from joint pressure, shorter recovery times, and improved clinical outcomes after TKA with any of the HTO interventions with no significant difference.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 16 June 2026

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History

  • Receive Date: 25 April 2026
  • Revise Date: 18 May 2026
  • Accept Date: 27 April 2026

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