What question did this study set out to answer?

This review aims to compare the effectiveness and safety of medial opening wedge and lateral closing wedge high tibial osteotomies for correcting knee osteoarthritis.

April 25, 2026

No differences between medial opening and lateral closing wedge high tibial osteotomies to correct coronal alignment or cumulative rates of conversion to knee arthroplasty: A systematic review with meta‐analysis

Key Points

This review aims to compare the effectiveness and safety of medial opening wedge and lateral closing wedge high tibial osteotomies for correcting knee osteoarthritis.
Systematic review and meta-analysis of studies on MOW and LCW high tibial osteotomies published until April 2024.
Analysis included 103 studies with 12,200 knees, focusing on imaging measurements and conversion rates to knee arthroplasty.
Meta-analysis reported mean differences for continuous outcomes and risk ratios for dichotomous outcomes.
No significant differences in coronal plane alignment between MOW and LCW techniques.
MOW had a lower risk of revision (RR = 0.34, 95% CI 0.19–0.61).
Overall complication rate was 22.2%, with conversion rates to knee arthroplasty of 6.4% at 5 years, 13.8% at 10 years, and 33.4% at 15 years.

Abstract

Abstract Purpose This systematic review with meta‐analysis aimed to compare the accuracy correction of lateral closing wedge (LCW) and medial opening wedge (MOW) high tibial osteotomies (HTO) in patients with knee osteoarthritis (OA), and to evaluate the proportion of complications, reinterventions, revisions and conversion to knee arthroplasty. Methods PubMed, EMBASE and Web of Science were searched until April 2024 to identify studies reporting imaging measurements, complications, reinterventions, revisions, and conversion to knee arthroplasty after HTO for knee OA. Meta‐analysis was performed to compare LCW and MOW. Meta‐analyses are reported as mean differences (MD) for continuous outcomes, or proportions and risk ratio (RR) for dichotomous outcomes, with 95% confidence intervals (CI). Results A total of 103 studies (MOW, 43 studies; LCW, 33 studies; both techniques, 27 studies) were included comprising 12,200 knees from 11,472 patients (50.2% females, 52.4 ± 6.5 years old and 21.5 ± 12.2 kg/m²). Imaging measurements identified no significant differences between LCW and MOW in coronal plane alignment. Posterior tibial slope (PTS) was significantly higher in MOW as compared to the LCW (MD = 3.72°, 95% confidence interval CI 2.31°−5.13°). Proportion of complications was high at 22.2% (95% CI 17.6%–27.0%) and the conversion to knee arthroplasty was 6.4% (95% CI 2.7%–11.3%) at 5 years, 13.8% (95% CI 7.8%–21.1%) at 10 years and 33.4% (95% CI 15.0%–54.6%) at 15 years. There were no differences between MOW and LCW in risk of complications or proportion of conversion to knee arthroplasty, but risk of revision was lower in MOW (RR = 0.34, 95% CI 0.19–0.61). Conclusions The MOW and LCW were comparable to correct the lower limb coronal plane alignment, but the LCW was superior in reducing the PTS angle. Both techniques showed a similar risk profile for complications, reintervention and conversion to knee arthroplasty, but the MOW had a 66% lower risk for revision. Level of Evidence Level IV.

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Cite This Study

Pinto et al. (Thu,) studied this question.

synapsesocial.com/papers/69ec5b3d88ba6daa22daccb3 https://doi.org/https://doi.org/10.1002/ksa.70400

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