# Palliative high tibial osteotomy achieves comparable outcomes to corrective osteotomy in varus knees with medial compartment osteoarthritis: A long‐term clinical and radiological retrospective study

## TL;DR

This study shows that palliative high tibial osteotomy provides long-term results similar to corrective osteotomy for varus knees with osteoarthritis.

## Contribution

The study provides long-term clinical and radiological evidence supporting palliative osteotomy as a viable alternative to corrective osteotomy.

## Key findings

- Both palliative and corrective osteotomies showed significant clinical improvement with no major differences between groups.
- Palliative osteotomy had comparable arthroplasty-free survival and low conversion rates to total knee arthroplasty.
- Despite less optimal correction of joint line obliquity, palliative osteotomy preserved joint function effectively.

## Abstract

The long‐term outcomes of palliative high tibial osteotomy (PO) remain insufficiently defined. This study compared the clinical and radiological outcomes of PO with those of corrective osteotomy (CO) in patients with varus knee deformity. Secondary aim was to evaluate arthroplasty‐free survival. It was hypothesized that PO and CO would yield comparable results and similar conversion rates to total knee arthroplasty (TKA).

A retrospective cohort study was conducted on patients who underwent lateral closing wedge‐high tibial osteotomy (LCW‐HTO) between 2001 and 2017. Patients with extra‐articular varus deformity (hip–knee–ankle angle [HKA] < 177°, lateral distal femoral angle [LDFA] > 90° or medial proximal tibial angle [MPTA] < 85°) were assigned to the CO group. Those with intra‐articular deformity and normal MPTA and LDFA were assigned to the PO group. Radiographic evaluation included HKA, MPTA, LDFA, joint line obliquity (JLO) and joint line convergence angle (JLCA). Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score, International Knee Documentation Committee (IKDC) subjective score, Numeric Rating Scale (NRS) for pain, Tegner Activity Scale and Crosby–Insall grading.

Forty patients were included, 20 in each group. The mean age was 49 ± 11 years, and the mean follow‐up was 10.5 ± 2.9 years. Preoperative HKA averaged 174° ± 3.3° and improved to 179° ± 1.5°. Moreover, 25% of PO patients and 10% of CO patients postoperatively exceeded the JLO threshold of ≤4°. Both groups demonstrated significant clinical improvement, with no between‐group differences except for higher HSS scores in the PO group. Osteoarthritis (OA) progression was limited, and TKA conversions were infrequent.

PO may represent an effective joint‐preserving option for intra‐articular varus deformity. Despite less optimal correction of JLO and JLCA, PO achieved clinical and radiological outcomes comparable to CO, with similarly low conversion rates to TKA.

Level IV, retrospective cohort study.