Closing-Wedge and Opening-Wedge High Tibial Osteotomy as Successful Treatments of Symptomatic Medial Osteoarthritis of the Knee: A Randomized Controlled Trial

Closing-wedge high tibial osteotomy (CWHTO) and opening-wedge high tibial osteotomy (OWHTO) are commonly used osteotomy techniques for the symptomatic knee osteoarthritis treatment. However, there is no consensus on which method provides superior outcomes. In this study, we compared the clinical outcomes, radiologic outcomes, and postoperative complications of these techniques. In a randomized controlled trial, 76 patients with medial compartment knee osteoarthritis and associated varus malalignment were randomized into the CWHTO and OWHTO groups (n=38). The primary outcome measures were knee function evaluated by Knee Injury and Osteoarthritis Outcome Score (KOOS) and knee pain assessed by a visual analog scale. The secondary outcome measures were posterior tibial slope (PTS), tibial bone varus angle, and postoperative complications. Both techniques significantly improved the clinical and radiologic outcome measures. The mean improvement of total KOOS was not significantly different between the CWHTO and OPHTO groups (P=0.55). Moreover, the improvement in various KOOS subscales was not significantly different between the two groups. The mean improvement of Visual Analogue Scale (VAS) was not significantly different between the CWHTO and OWHTO groups (P=0.89). The mean PTS change was not significantly different between the two groups (P=0.34). The mean improvement of the varus angle was not significantly different between the two groups (P=0.28). The rate of postoperative complications was not remarkably different between the CWHTO and OWHTO groups. Considering no observed superiority of each osteotomy technique over the other one, two techniques could be used interchangeably and based on the surgeon's preference. Level of evidence: I