Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis

Abstract

This meta-analysis was designed to compare the longevity of the survivorship of opening versus closing wedge high tibial osteotomy (HTO). All studies reporting survival rates in patients who underwent open or closed wedge HTO with more than 5-year follow-up duration were included in the meta-analysis. Survival time was considered as time to conversion to TKA. Twenty three studies were included in meta-analysis, 20 of which were of level IV evidence. The pooled 5-year survival rates were 95.1% (95% CI: 93.1 to 97.1%) in open wedge HTO and 93.9% (95% CI: 93.1 to 94.6%) in closed wedge HTO. Although there was 1.2% greater survival rate in open wedge HTO than in closed wedge HTO, this difference did not reach statistical significance (P = 0.419). Pooled 10-year survival rates were 91.6% (95% CI: 88.5 to 94.8%) in open wedge HTO and 85.4% (95% CI: 84.0 to 86.7%) in closed wedge HTO, indicating that open wedge HTO had 6.2% greater survival rate 10 years after surgery than did closed wedge HTO (P = 0.002). No difference in 5-year survivorship was found between open- and closed-wedge HTO. However, the survival rate was higher in open-wedge HTOs than in closed wedge HTO at 10 years.

Figure 1

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) flow diagram of the identification and selection of the studies included in this meta-analysis.

Figure 2

Funnel plot showing relatively symmetrical data on (A) 5-year survivalship of closed wedge high tibial osteotomy (HTO) and asymmetricity on (B) 10-year survivalship of closed wedge HTO.

Figure 3

Forest plot showing the pooled 5-year survival rates of open wedge (A) and closed wedge (B) high tibial osteotomies.

Figure 4

Forest plot showing the pooled 10-year survival rates of open wedge (A) and closed wedge (B) high tibial osteotomies.