High tibial osteotomy in Sweden, 1998–2007: A population-based study of the use and rate of revision to knee arthroplasty

BACKGROUND AND PURPOSE: Most studies on high tibial osteotomies (HTOs) have been hospital-based and have included a limited number of patients. We evaluated the use and outcome—expressed as rate of revision to knee arthroplasty—of HTO performed in Sweden with 9 million inhabitants, 1998–2007. PATIENTS AND METHODS: 3, 161 HTO procedures on patients 30 years or older (69% men) who were operated on for knee osteoarthritis in Sweden, 1998–2007, were identified through the inpatient and outpatient care registers of the Swedish National Board of Health and Welfare. Pertinent data were verified through surgical records. Conversions of HTO to knee arthroplasty before 2010 were identified through the Swedish Knee Arthroplasty Register (SKAR). The 10-year survival was determined using revision to an arthroplasty as the endpoint. RESULTS: The number of HTOs decreased by one third between 1998 and 2007, from 388 operations a year to 257 a year. Most of the HTOs were performed with open wedge osteotomy using external fixation. The cumulative revision rate at 10 years was 30% (95% CI: 28–32). The risk of revision increased with increasing age and was higher in women than in men (RR = 1.3, CI: 1.1–1.5). INTERPRETATION: If being without an artificial joint implant is considered to be beneficial, then HTO is an excellent alternative to knee arthroplasty in younger and/or physically active patients suffering from knee osteoarthritis.