Outcome of Medial Open Wedge High Tibial Osteotomy for Knee Osteoarthritis: A Case Series

Medial compartment knee osteoarthritis (OA) with varus alignment is a common degenerative condition leading to pain, functional limitation, and reduced quality of life. High tibial osteotomy (HTO) by the open wedge technique is a joint-preserving option aimed at realigning the mechanical axis.

This study aims to evaluate the functional and radiological outcomes of medial open wedge HTO in patients with medial knee OA and varus deformity.

We conducted a prospective study at Hamidia Hospital, Bhopal, for 2 years with 6 months follow-up of each patient. Twenty-five patients of symptomatic medial compartment OA diagnosed by standing X-rays and Scannogram, underwent medial open wedge HTO using TomoFix plate. Outcome was assessed using standing X-rays, visual analog scale (VAS), and Western Ontario and McMaster Universities OA Index (WOMAC) scores. All patients were classified by the Kellgren-Lawrence (KL) system. We excluded patients with secondary knee OA.

In our patients, 72% of patients were elderly women, and the mean age was 62.76 years. Most had KL Grade 3 OA (72%), with the left knee more commonly affected (62.5%). Although we have not found a significant improvement at 4 weeks, theVAS score improved from 6 weeks onward (P < 0.001), with mean VAS 4.48 at 12 weeks and 3.44 at 18 weeks, respectively. WOMAC score also improved at 6 weeks (mean change: 2.32, P = 0.022) and at 12, 18, and 24 weeks (mean changes: 11.64, 21.92, and 35.56, respectively; all P < 0.001). Radiologically, a mean correction of 9.72° (±0.89) was achieved, with successful restoration of mechanical alignment for a mean varus of 2.40 ± 0.65°.

Medial open wedge HTO is an effective treatment modality for selected patients with medial compartment OA and varus alignment. It provides significant pain relief and functional improvement. Proper patient selection, pre-operative planning, surgical technique, and rehabilitation are critical for optimal outcomes.