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High Tibial Osteotomy Survivorship: Opening- versus Closing-wedge
161
relatively similar in many respects, but it is
possible that other unquantified differences
between the groups existed, potentially biasing
our results. Further, because HTO was
performed at a variety of centers for a variety
of indications, we lack details about these
procedures, which again could reflect group
differences for which we did not control.
Finally, due to the evolution of the HTO
surgical technique over time, the time from
HTO to TKA in the lateral closing-wedge group
was considerably longer than that in the medial
opening-wedge group. The medial opening-
wedge group thus exhibited earlier progression
to TKA than did the lateral closing-wedge
group. This difference could reflect the intrinsic
differences between these patient populations,
which may influence their outcome after TKA.
Only an evaluation of TKA outcomes in
patients who were initially randomized to one
type of osteotomy or the other can effectively
control for these differences.
The conclusions of this study may have been
influenced by intrinsic differences between the
patient populations as well as variability among
the sites and professionals involved in the
osteotomy procedures. For this reason, we
cannot categorically state that one osteotomy
technique is superior to another in terms of
survival. This study has the objective to reflect
about this subject and future studies with
patients initially randomized to one type of
osteotomy or another will provide more
accurate and definitive results. This will lead to
more effective techniques and lower costs.
Conclusion
Compared with OWO, CWO was associated
with greater survival until performance of
TKA. We identified a positive and significant
relationship between patient age at the time of
the osteotomy and survival.
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