ISAKOS Congress 2021

2021 ISAKOS Biennial Congress ePoster


Outcome Of High Tibial Osteotomy For Kellgren-Lawrence Grade Iii/Iv Knee Osteoarthritis: Two To Nine Years Follow-Up

Priyadarshi Amit, MS, DNB, MRCSEd, MCh, FRCS, London UNITED KINGDOM
Ravi Thimmaiah, FRCS, Birmingham UNITED KINGDOM
Martyn Snow, FRCS, Birmingham UNITED KINGDOM

The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UNITED KINGDOM

FDA Status Not Applicable


High tibial osteotomy is a good option in grade III/IV arthritis with low revision rate at 5years.

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High tibial osteotomy is an established surgical modality for the treatment of medial compartment knee pain secondary to a spectrum of pathology ranging from meniscus deficiency to degenerative joint disease. However, Kellgren-Lawrence (KL) grade III and IV disease is commonly considered as a contraindication by some authors. The aim of our study was to report the survival of high tibial osteotomy in patients with advanced KL grade III/IV osteoarthritis.


All patients who underwent high tibial osteotomy at our center by senior author between January 2009 until August 2017 were included in the review. Weightbearing AP plain X-rays were used to classify all patients according to the KL grading. Operative records and patient notes were reviewed to document complications or the need for repeat surgery or conversion to TKR. Failure was defined as the need for total knee replacement. As the data was in absolute numbers, it was presented as mean and percentages. Kaplar Meier survivorship was calculated.


124 patients were identified who had undergone high tibial osteotomy within the defined duration, of which 18 had grade III and 35 had grade IV osteoarthritis. Mean age was 45.83?6.03 (range 34-56) years. There were 37 males and 16 females. All patients had medial opening wedge high tibial osteotomy using Tomofix in 22 patents and Newclip plate in 31 patients. Four patients had simultaneous additional lateral closing wedge distal femoral osteotomy to correct severe varus alignment. Patients had adjunctive procedure in form of microfracture of the trochlea in six patients. Follow-up period ranged from two to nine years. There were no failures in grade III arthritis where seven of 18 completed at least five years follow-up. In grade IV arthritis, 17 patients had at least 5 years follow-up with one failure at 51 months, six patients had 5-8 years follow-up with one failure at 90 months, and one patient had more than 8 years follow-up which failed at 115 months. The five-year survival rate was 100% and 95% for grade III and IV respectively.


High tibial osteotomy is a good option in grade III/IV arthritis with low revision rate at 5years.

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