HTO is a good option in the older patient: a single surgeon case series


The number of high tibial osteotomies (HTOs) are increasing year on year as documented in the United Kingdom Knee Osteotomy Registry (UKKOR). There is a paucity of evidence for their use in the older patient. Traditionally they are reserved for select, younger patients wishing to defer the need for total knee arthroplasty for a few more years. Approximately 70% of HTOs are performed on patients between 40 and 55 years of age.


50 adult patients underwent consecutive HTOs for medial compartment osteoarthritis under the same Consultant Orthopaedic Surgeon at the Warrington & Halton NHS Hospital Trust from 2014 onwards. Validated Patient Reported Outcome Measure (PROM) scores were collected prospectively. Oxford and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were collected at 1 year, 2 year and up to 5 years. The cohort was divided into two groups based on age: group 1 were 53 years old or above. Those who were 52 or below were in group 2.


Both patient groups had comparable demographics and baseline PROMs scores. Group 1 had 27 patients with an age range between 53 and 71 years. Group 2 had 23 patients ranging from 26 to 52 years of age. There was no significant difference between the scores at either 1 year or 2 years (p<0.12, p<0.13).


With good clinical acumen and appropriate patient selection HTO is a good option in the older patient with patients reporting just as good results in terms of pain, function, sport and quality of life as their younger counter parts.

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