Differences Between Open-Wedge Versus Closed-Wedge High Tibial Osteotomy On Clinical And Radiological Outcomes And Adverse Events

High tibial osteotomy (HTO) is a widely accepted procedure to treat medial knee osteoarthritis, which is performed either with open-wedge (OWO) or closed-wedge osteotomy (CWO). This meta-analysis was designed to evaluate whether OWO had an advantage over CWO regarding the clinical and radiographic results, and complications. Multiple comprehensive databases, including PubMed, Embase, Web of Science and Cochrane Library, were searched from their inception to October 2017. A total of 28 publications reporting 24 clinical trials were finally eligible. The OWO showed significantly greater posterior tibial slope compared to CWO, and the result remained unchanged over time. Moreover, patellar height decreased after OWO, but increased after CWO. No significant difference was detected for complications, such as infection, re-operation, nonunion, and revision to joint arthroplasty. No difference was found between them regarding the improvement of pain and knee function. Although both techniques led to the good and comparable clinical results, we recommended OWO as an alternatively effective treatment option for selected younger patients, which is easier to perform and to convert to TKA, avoids tibiofibular joint disruption and common peroneal nerve palsy, and permits multiplanar correction, as compared to CWO. However, additional well-designed studies are required to identify fixation type and augment selection in OWO.