Postoperative Outcomes Following High Tibial Osteotomy in Patients Over 55 Years of Age: A Systematic Review

To systematically review the literature to better understand outcomes and complications following high tibial osteotomy (HTO) in patients aged ≥55 years, a population in which HTO remains controversial, with advanced age suggested to be a negative predictor of outcomes. PubMed, Embase, Cochrane, and Scopus databases were searched from inception to April 2026 to identify studies reporting outcomes following HTO in patients aged ≥55 years. Studies reporting operative approach, complications, reoperations, and radiographic and/or patient-reported outcomes were included. Twenty-four studies comprising 21,261 patients (weighted mean age 64.7 years [range, 55-86]; 74% male) undergoing HTO were identified, with a weighted mean follow-up of 57.5 months (range, 10.0-132.2). Preoperatively, 57.0% (n = 362/635) of patients had Kellgren-Lawrence (K-L) grade 3 changes, followed by grade 2 (28.0%, n = 178/635) and grade 4 (14.2%, n = 90/635). Opening-wedge HTO was performed in 87.5% (n = 1,115/1,275) of cases reporting surgical approach, while 12.5% (n = 160/1,275) underwent a closed-wedge procedure. Concomitant diagnostic arthroscopy and/or debridement were performed in 95.4% (n = 433/454) of patients reporting concomitant procedures, with meniscectomy and osteochondral autograft transplantation performed in 54.4 and 9.7% of cases, respectively. At final follow-up, conversion to knee arthroplasty was reported in a subset of patients, with a pooled rate of 8.6% (n = 53/619). Post-surgical complications were reported in 2.3% (n = 471/20,777) of patients among studies reporting complications, including infection (0.9%) and lateral hinge fracture (0.3%). Radiographically, the weighted mean femorotibial angle decreased from 179.6 to 171.7 degrees, while mean tibial slope increased from 9.7 to 10.0 degrees. Mean visual analog scale scores decreased from 6.0 to 3.0, while mean Lysholm and Japanese Orthopaedic Association Knee scores improved from 57.4 to 78.0 and 67.5 to 90.2, respectively. HTO in patients aged ≥55 years is most commonly performed for symptomatic medial compartment chondrosis, primarily K-L grade 3, using an open-wedge approach. Low complication rates and improvements in alignment, knee function, and patient-reported outcomes were reported.