Abstract Purpose To evaluate the long‐term outcomes of medial open‐wedge high tibial osteotomy (MOWHTO), focusing on conversion to knee arthroplasty and to summarize prognostic factors for conversion reported in the literature. Methods A systematic review and meta‐analysis were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. Multiple databases were searched up to March 2025. Eligible studies reporting ≥10‐year survival rates of MOWHTO—defined as the avoidance of conversion to knee arthroplasty—were included. Data were synthesized using a random‐effects model. Subgroup analyses were performed based on region. Results A total of 16 studies encompassing 1906 knees were included in the final analysis. The pooled long‐term non‐conversion proportions following MOWHTO, defined as avoidance of knee arthroplasty, was 86% (95% confidence interval CI: 80%–90%). Numerically higher long‐term non‐conversion proportions were observed in Asian studies (92%) compared with European studies (84%). Narrative synthesis indicated durable long‐term functional outcomes, with most patients avoiding arthroplasty for at least a decade. Conclusions MOWHTO provides durable long‐term outcomes, with an overall long‐term non‐conversion proportion of 86%. These findings could facilitate more personalized treatment strategies for different populations worldwide and ultimately reduce the socioeconomic burden associated with knee arthroplasty. Level of Evidence Level IV, systematic review and meta‐analysis of Levels III–IV studies.
Ge et al. (2026) studied this question.