Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis.
High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient.
Department of Orthopedics, the Fifth Affiliated Hospital & Central Hospital of Lishui City of Wenzhou Medical University, Lishui, China.
Lingfeng
L
Wu
Department of Orthopedics, Qingyuan Country People's Hospital, Lishui, China.
Jun
J
Lin
Department of Surgery, Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China.
Zhicheng
Z
Jin
Department of Orthopedics, the Fifth Affiliated Hospital & Central Hospital of Lishui City of Wenzhou Medical University, Lishui, China.
Xiaobin
X
Cai
Department of Orthopedics, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Weiyang
W
Gao
D000328:Adult; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000601:surgery; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011859:Radiography; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016059:Range of Motion, Articular / Q000502:physiology; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult