Comparison of closing wedge and opening wedge high tibial osteotomy

Background and purpose: High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthritis. Two basic HTO techniques are performed commonly, a lateral closing-wedge HTO and a medial opening-wedge HTO. Previous studies have not consistently demonstrated either technique to offer more clinical advantage than the other. Material and methodology: From 2019 to 2020, one hundred patients were randomized to receive either a closing-wedge or an opening-wedge high tibial osteotomy. The clinical outcome and radiographic results were examined preoperatively, at 2, 6 and 18 months postoperatively. Main demographic variables such as age, gender, body mass index (BMI) and previous non-surgical treatment data were collected and reviewed. The outcomes that we reviewed include maintenance of the achieved correction (pre- and postoperative wight bearing line, medial proximal tibial angle), progression of osteoarthritis (based on the Kellgren and Lawrence classification), severity of pain and quality of life (as assessed with an Oxford and a Lysholm knee score), knee function (pre- and postoperative knee range of motion), surgical duration and complications. Data analysis calculated by using Stata 13.0. Results: The mean age of study participants was 51±6 and 10 percent of those were men. The 51 percent of the total subjects underwent the lateral closing-wedge high tibial osteotomy and remained 49% received the medial opening-wedge technique. At 18 months, percent of weight bearing line increased to 57.1±4.2 in lateral closing-wedge osteotomy group and 58.8±4.0 in medial opening-wedge osteotomy group. The mean medial proximal tibial angle was 92.8±2.7 in lateral closing-wedge osteotomy group and 92.8±3.0 in medial opening-wedge osteotomy. The Oxford knee score and Lysholm knee score significantly increased at 6 months and 18 months follow-up in both study groups compared to pre-operation assessment (p < 0.0001). At 2 months follow-up period, participants in both groups obtained significantly lower score in the Oxford and Lysholm knee scale compared to both pre-operation and final assessment. Conclusion: Both method of tibial osteotomy, medial opening wedge and lateral closing wedge, depicted satisfactory result in our study. However, medial opening wedge technique may provide surgeons better possibility to correct weight bearing line more accurately than lateral closing wedge method.