title: Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy.
abstract: OBJECTIVE
  Medial opening wedge high tibial osteotomy (HTO) has become increasingly popular as an alternative to lateral closing wedge osteotomy for the treatment of medial compartment knee osteoarthritis with varus deformity. The present systematic review was conducted to provide an objective analysis of total knee arthroplasty (TKA) outcomes following previous knee osteotomy (medial opening wedge vs. lateral closing wedge).
  
  
  METHODS
  A literature search of online databases (MEDLINE, EMBASE, Cochrane Library database) was made, in addition to manual search of major orthopaedic journals. The methodological quality of each of the studies was assessed on the Newcastle-Ottawa Scale and Effective Practice and Organization of Care. A total of ten studies were included in the review. There were eight studies with Level IV and two studies with Level III evidence.
  
  
  RESULTS
  Eight studies reported clinical and radiologic scores. Comparative studies between TKA following medial opening and lateral closing wedge HTO did not demonstrate statistically significant clinical and radiologic differences. The revision rates were similar. However, more technical issues during TKA surgery after lateral closing wedge HTO were mentioned than the medial open wedge group. The quadriceps snip, tibial tubercle osteotomy, and lateral soft tissue release were more frequently needed in the lateral closing wedge HTO group. In addition, because of loss of proximal tibia bone geometry in the lateral closing wedge HTO group, concerns such as tibia stem impingement in the lateral tibial cortex was noted.
  
  
  CONCLUSIONS
  The present systematic review suggests that TKA after medial opening and lateral closing wedge HTO showed similar performance. Clinical and radiologic outcome including revision rates did not statistically differ from included studies. However, there are more surgical technical concerns in TKA conversion from lateral closing wedge HTO than from the medial opening wedge HTO group.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Ilsan, 411-706, 2240, Daehwa-dong, Ilsan-Segu, Koyang-Si, Ilsan, Republic of Korea.|Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea.
authors.forename: Jae Hwi
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Jae-Hyuk
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Department of Orthopedic Surgery, Bhandare Hospital, Panaji, Goa, India.
authors.forename: Nikhl N
authors.initials: NN
authors.lastname: Bhandare
authors.affiliation: Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Suh
authors.affiliation: Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Ilsan, 411-706, 2240, Daehwa-dong, Ilsan-Segu, Koyang-Si, Ilsan, Republic of Korea.
authors.forename: Jong Seong
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Ilsan, 411-706, 2240, Daehwa-dong, Ilsan-Segu, Koyang-Si, Ilsan, Republic of Korea.
authors.forename: Yong Suk
authors.initials: YS
authors.lastname: Chang
authors.affiliation: Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Ilsan, 411-706, 2240, Daehwa-dong, Ilsan-Segu, Koyang-Si, Ilsan, Republic of Korea.
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Yeom
authors.affiliation: Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Ilsan, 411-706, 2240, Daehwa-dong, Ilsan-Segu, Koyang-Si, Ilsan, Republic of Korea. kwnhamj@hotmail.com.
authors.forename: Kyung Wook
authors.initials: KW
authors.lastname: Nha
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D052097:Quadriceps Muscle / Q000601:surgery; D012086:Reoperation; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
keywords: Closed; High tibial osteotomy; Open; Systematic review; Total knee arthroplasty