The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Clinical Outcomes and Complications of Total knee Arthroplasty Following Previous Opening vs. Closing-Wedge High Tibial Osteotomy: A Systematic Review

Document Type : SYSTEMATIC REVIEW

Authors
Mohammad Amin Khojastehnezhad 1
Mohammad H. Ebrahimzadeh 1
Mohsen Dehghani 2
Maedeh Sharafoddin 1
Ali Moradi 1
Fatemeh Nikbakht 3
Nafiseh Jirofti 1
1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
3 Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
10.22038/abjs.2026.95154.4275
Abstract
Objectives: Two frequently used surgical interventions for knee joint osteoarthritis include closing wedge high tibial osteotomy (CW-HTO) and opening wedge high tibial osteotomy (OW-HTO). Studies showed that, most to near all cases lead to failure, requiring a total knee arthroplasty (TKA). This systematic review aimed at answering this question: What are the outcomes of TKA following CW-HTO and OW-HTO?
Methods: The main electronic databases were searched up to November 2025. Only studies that included comparative arms for both closing-wedge high tibial osteotomy (CW-HTO) and opening-wedge high tibial osteotomy (OW-HTO) were considered for further assessment. The primary outcomes included knee joint function scores, such as the International Knee Society (IKS) score and the Knee Society Score (KSS). A meta-analysis was not feasible because of heterogeneity in the reported data and follow-up periods. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the methodological quality of each included study.
Results: Of the 6,756 records identified and screened, three comparative clinical studies, including a total of 541 TKA cases, were included in this systematic review. Two studies reported no significant difference in KSS or range of motion after TKA between patients who had previously undergone CW-HTO and those who had undergone OW-HTO. However, one study reported improvements in walking ability in both groups after 80–90 months of follow-up. Post-operative complication rates were comparable between groups (OW-HTO: 12.3% vs. CW-HTO: 8.3%); however, one study noted a significantly higher incidence of specific complications, such as skin necrosis and nerve injury, in the CW-HTO cohort (12% vs. 6%, P<0.05). Intra-operative complications were rare, affecting 2.8% of cases with no significant between-group difference.
Conclusion: The limited available evidence precludes definitive conclusions. Current data suggest potential benefits after TKA following either CW-HTO or OW-HTO, including earlier relief of joint loading, shorter recovery time, and improved clinical outcomes, with no significant differences in clinical outcomes and complications between the two HTO techniques.
Level of evidence: V
Keywords
Closing wedge high tibial osteotomy
Knee osteoarthritis
Opening wedge high tibial osteotomy
Systematic review
Total knee arthroplasty
Subjects

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The Archives of Bone and Joint Surgery
Volume 14, Issue 7
July 2026
Pages 426-435

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