High tibial osteotomy improves function and alignment in patients above and below 50 Years: A systematic review
Bibliographic record
Abstract
Medial knee osteoarthritis (MKOA) is a debilitating condition frequently affecting younger, active individuals. Medial opening-wedge high tibial osteotomy (HTO) is a joint-preserving surgical technique that realigns the mechanical axis to offload the medial compartment. While traditionally reserved for younger patients, interest is growing in its use among older adults. This systematic review evaluated the functional outcomes of HTO in patients under and over 50 years of age to support age-informed surgical decision-making. Medline, Embase, CINAHL, and Web of Science were searched through December 2024. Inclusion criteria were: (1) mean age reported to allow classification as under or over 50 years, (2) follow-up >12 months, and (3) reporting of validated PROMs after HTO for medial compartment OA. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS), and descriptive statistics summarized findings. Fifteen studies comprising 995 patients were included: 395 under age 50 and 600 aged 50 or older. HTO led to consistent improvements in PROMs across both groups, including Lysholm, IKDC, OKS, and HSS scores, with greater gains typically observed in the younger cohort. Younger patients also demonstrated superior mechanical axis alignment (P ≤ 0.003), higher return-to-sport rates, and more pronounced pain reduction. Radiographic outcomes confirmed reliable correction from varus to neutral or valgus alignment, including improvements in mechanical axis, anatomical femoral-tibial angle, and weight-bearing line ratio. No studies reported deterioration in alignment or PROMs at follow-up. HTO appeared to improve function and alignment in patients under and over 50 years. While younger individuals experienced greater absolute gains, older adults also achieved substantial clinical benefits. These findings support HTO as a joint-preserving option in appropriately selected older patients. Further prospective studies are needed to better define age-related differences in long-term outcomes. IV, systematic review.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.005 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".