title: Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee.
abstract: BACKGROUND
  The management of degenerative arthritis of the knee in the younger, active patient presents a challenge to the orthopaedic surgeon. Surgical treatment options include high tibial osteotomy (HTO), unicompartmental knee arthroplasty, and total knee arthroplasty.
  
  
  OBJECTIVE
  To examine the long-term survival of closing wedge HTO in a large series of patients up to 19 years after surgery.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Four hundred fifty-five consecutive patients underwent lateral closing wedge HTO for medial compartment osteoarthritis between 1990 and 2001. Between 2008 and 2009, patients were contacted via telephone, and assessment included incidence of further surgery, current body mass index (BMI), Oxford Knee Score, and British Orthopaedic Association Patient Satisfaction Scale. Failure was defined as the need for revision HTO or conversion to unicompartmental knee arthroplasty or total knee arthroplasty. Survival analysis was completed using the Kaplan-Meier method.
  
  
  RESULTS
  High tibial osteotomy survival was determined in 413 patients (91%). Of the 397 remaining living patients at the time of final review, 394 (99%) were contacted for follow-up via telephone interview. The probability of survival for HTO at 5, 10, and 15 years was 95%, 79%, and 56%, respectively. Multivariate regression analysis showed that age under 50 years (P = .001), BMI less than 25 (P = .006), and ACL deficiency (P = .03) were associated with better odds of survival. Mean Oxford Knee Score was 40 of 48 (range, 17-48). Overall, 85% of patients were enthusiastic or satisfied, and 84% would undergo HTO again at a mean 12 years of follow-up.
  
  
  CONCLUSIONS
  High tibial osteotomy can be effective for periods longer than 15 years; however, results do deteriorate over time. Age less than 50 years, normal BMI, and ACL deficiency were independent factors associated with improved long-term survival of HTO.
authors.affiliation: North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hui
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Salmon
authors.forename: Alison
authors.initials: A
authors.lastname: Kok
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Williams
authors.forename: Niels
authors.initials: N
authors.lastname: Hockers
authors.forename: Willem M
authors.initials: WM
authors.lastname: van der Tempel
authors.forename: Rishi
authors.initials: R
authors.lastname: Chana
authors.forename: Leo A
authors.initials: LA
authors.lastname: Pinczewski
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000401:mortality* / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult