High tibial osteotomy: why we choose a lateral closing wedgetechnique and what is our “ideal” patient?

Background: High tibial osteotomy (HTO) is indicated for medial compartment knee osteoarthritis in young, active patients to delay total knee replacement (TKR), which carries higher failure rates in this demographic. The procedure aims to redistribute mechanical loading from the degenerated medial compartment to the preserved lateral compartment.

Objective: This article describes a specific lateral closing wedge HTO technique and evaluates preoperative predictors of long-term clinical success and survivorship.

Key Points: The described technique utilizes a modified Coventry approach with a Krakow staple for stabilization, facilitating primary bone healing and early mobilization. In cases of medial collateral ligament pseudolaxity, a combined lateral closing and medial opening wedge modification is employed. A prospective 10-year study of 95 patients demonstrated an overall survivorship of 79% at 10 years. Three preoperative variables were significantly associated with superior outcomes: age under 55 years, body mass index (BMI) below 30 kg/m², and a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score exceeding 45. Patients meeting these "ideal" criteria achieved a 97% survivorship rate at 10 years, compared to 69% for those with suboptimal preoperative profiles.

Conclusion: Lateral closing wedge HTO provides durable functional improvement and high patient satisfaction. Precise patient selection based on age, BMI, and preoperative functional scores is essential to optimize long-term survivorship and clinical outcomes.