Clinicoradiologic Outcomes of Medial Open-Wedge High-Tibial Osteotomy Are Equivalent in Bone-on-Bone and Non–Bone-on-Bone Medial Osteoarthritis

Published:September 27, 2020DOI:



      (1) To investigate whether patients with bone-on-bone (BOB) medial OA (Ahlback grade 2) had comparable clinical improvement to those with non-BOB arthritis with remaining joint space (Ahlback grades 0/1) after medial open-wedge high tibial osteotomy (MOWHTO); (2) to determine whether the radiological results differ between these 2 groups from 1 month postoperatively to last follow-up ≥2 years later.


      Data of 132 knees (40 males and 92 females) who underwent MOWHTO were retrospectively reviewed. Preoperative standing anteroposterior radiographs were evaluated according to the Ahlback classification. Patients with Ahlback grade ≤1 were classified as the non-BOB group (group I, n = 88; mean age, 50.5 ± 6.3 years) and those with grade 2 as the bone-on-bone group (group II, n = 44; age, 51.6 ± 5.3 years). Clinical outcomes were assessed using Hospital for Special Surgery (HSS) and Knee Society (KS) functional scores. Medial joint space width (JSW), medial proximal tibial angle (MPTA), and mechanical alignment were considered radiological parameters.


      Preoperative clinical scores were significantly lower in patients with BOB arthritis (HSS score: group I, 73.5 ± 10.7 versus group II, 69.2 ± 9.1, P = .026; KS score: group I, 72.9 ± 10.3 versus group II, 63.2 ± 11.6 points, P < .001). However, HSS and KS functional scores improved in both groups without a significant difference at a mean follow-up of 3.4 ± 2.5 and 4.1 ± 3.1 years in groups I and II, respectively (HSS score: 89.2 ± 9.5 versus 89.4 ± 7.3 points, P = .258; KS functional score: 90.1 ± 7.1 versus 87.8 ± 8.9 points, P = .105). Preoperative and postoperative medial JSWs were narrower in group II, but the JSW opening was wider in group II at 1 month after surgery and was maintained until the last follow-up (preoperative, 3.0 ± 0.9 versus 0.0 ± 0.1 mm; 1 month, 3.1 ± 1.0 versus 1.4 ± 0.8; last follow-up, 3.0 ± 1.0 versus 1.4 ± 0.9 mm; P < .001).


      Patients with BOB medial OA achieved clinical outcomes comparable to those with remaining joint space after MOWHTO. The medial JSW showed a significant increase without OA progression during midterm follow-up in these patients. Therefore, MOWHTO can be an effective treatment choice for symptomatic improvement in middle-aged patients with severe medial OA, if there is no subchondral bone attrition.

      Level of Evidence

      III, retrospective comparative study.
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        • Agneskirchner J.D.
        • Hurschler C.
        • Wrann C.D.
        • Lobenhoffer P.
        The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: A biomechanical study.
        Arthroscopy. 2007; 23: 852-861
        • Lee D.C.
        • Byun S.J.
        High tibial osteotomy.
        Knee Surg Relat Res. 2012; 24: 61-69
        • Hantes M.E.
        • Natsaridis P.
        • Koutalos A.A.
        • Ono Y.
        • Doxariotis N.
        • Malizos K.N.
        Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3199-3205
        • Parker D.A.
        • Beatty K.T.
        • Giuffre B.
        • Scholes C.J.
        • Coolican M.R.
        Articular cartilage changes in patients with osteoarthritis after osteotomy.
        Am J Sports Med. 2011; 39: 1039-1045
        • Ferruzzi A.
        • Buda R.
        • Cavallo M.
        • Timoncini A.
        • Natali S.
        • Giannini S.
        Cartilage repair procedures associated with high tibial osteotomy in varus knees: Clinical results at 11 years' follow-up.
        Knee. 2014; 21: 445-450
        • Castagnini F.
        • Sudanese A.
        • Bordini B.
        • Tassinari E.
        • Stea S.
        • Toni A.
        Total knee replacement in young patients: Survival and causes of revision in a registry population.
        J Arthroplasty. 2017; 32: 3368-3372
        • Bayliss L.E.
        • Culliford D.
        • Monk A.P.
        • et al.
        The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: A population-based cohort study.
        Lancet. 2017; 389: 1424-1430
        • Schuster P.
        • Gesslein M.
        • Schlumberger M.
        • et al.
        Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment.
        Am J Sports Med. 2018; 46: 1362-1370
        • Nha K.W.
        • Oh S.M.
        • Ha Y.W.
        • Patel M.K.
        • Seo J.H.
        • Lee B.H.
        Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2021-2029
        • Galli M.
        • De Santis V.
        • Tafuro L.
        Reliability of the Ahlback classification of knee osteoarthritis.
        Osteoarthritis Cartilage. 2003; 11: 580-584
        • Shon O.J.
        • Park S.J.
        • Shim B.J.
        • Lee D.Y.
        Comparative study of clinical and radiographic outcomes of high tibial osteotomy in patients with kissing lesions and non-kissing lesions.
        Knee Surg Relat Res. 2017; 29: 288-294
        • Sohn S.
        • Koh I.J.
        • Kim M.S.
        • Kang B.M.
        • In Y.
        What factors predict patient dissatisfaction after contemporary medial opening-wedge high tibial osteotomy?.
        J Arthroplasty. 2020; 35: 318-324
        • Spahn G.
        • Kirschbaum S.
        • Kahl E.
        Factors that influence high tibial osteotomy results in patients with medial gonarthritis: A score to predict the results.
        Osteoarthritis Cartilage. 2006; 14: 190-195
        • Raynauld J.P.
        • Martel-Pelletier J.
        • Haraoui B.
        • et al.
        Risk factors predictive of joint replacement in a 2-year multicentre clinical trial in knee osteoarthritis using MRI: Results from over 6 years of observation.
        Ann Rheum Dis. 2011; 70: 1382-1388
        • Efe T.
        • Ahmed G.
        • Heyse T.J.
        • et al.
        Closing-wedge high tibial osteotomy: Survival and risk factor analysis at long-term follow up.
        BMC Musculoskelet Disord. 2011; 12: 46
        • Floerkemeier S.
        • Staubli A.E.
        • Schroeter S.
        • Goldhahn S.
        • Lobenhoffer P.
        Outcome after high tibial open-wedge osteotomy: A retrospective evaluation of 533 patients.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 170-180
        • Bonasia D.E.
        • Dettoni F.
        • Sito G.
        • et al.
        Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: Prognostic factors.
        Am J Sports Med. 2014; 42: 690-698