{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:21:43Z","timestamp":1787613703407,"version":"build-2736575974"},"reference-count":44,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To systematically review the literature to better understand outcomes and complications following high tibial osteotomy (HTO) in patients aged \u226555 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 \u226555 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\u201386]; 74% male) undergoing HTO were identified, with a weighted mean follow-up of 57.5 months (range, 10.0\u2013132.2). Preoperatively, 57.0% (n\u2009=\u2009362\/635) of patients had Kellgren-Lawrence (K-L) grade 3 changes, followed by grade 2 (28.0%, n\u2009=\u2009178\/635) and grade 4 (14.2%, n\u2009=\u200990\/635). Opening-wedge HTO was performed in 87.5% (n\u2009=\u20091,115\/1,275) of cases reporting surgical approach, while 12.5% (n\u2009=\u2009160\/1,275) underwent a closed-wedge procedure. Concomitant diagnostic arthroscopy and\/or debridement were performed in 95.4% (n\u2009=\u2009433\/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\u2009=\u200953\/619). Post-surgical complications were reported in 2.3% (n\u2009=\u2009471\/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\u2009degrees, while mean tibial slope increased from 9.7 to 10.0\u2009degrees. 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 \u226555 years is most commonly performed for symptomatic medial compartment chondrosis, primarily K\u2013L grade 3, using an open-wedge approach. Low complication rates and improvements in alignment, knee function, and patient-reported outcomes were reported.<\/jats:p>","DOI":"10.1055\/a-2939-2700","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:45:53Z","timestamp":1787611553000},"source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Outcomes Following High Tibial Osteotomy in Patients Over 55 Years of Age: A Systematic Review"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9725-6503","authenticated-orcid":false,"given":"Siddhant","family":"Bhat","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, Missouri, United States","place":["St. Louis"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Touhey","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, Missouri, United States","place":["St. Louis"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4913-7115","authenticated-orcid":false,"given":"S. Ryan","family":"Pierson","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, Missouri, United States","place":["St. Louis"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew V.","family":"Smith","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, Missouri, United States","place":["St. Louis"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derrick M.","family":"Knapik","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, Missouri, United States","place":["St. Louis"],"department":["Department of Orthopaedic 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compartment osteoarthritis show similar outcomes and survivorship, while medial opening wedge has higher rates of tibial fracture and lcw has higher rates of nerve injury and conversion to total knee","volume":"41","author":"L V Tollefson","year":"2025","journal-title":"Arthroscopy"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.3928\/01477447-20221031-09","article-title":"Higher dissatisfaction rate following revision compared with primary total knee arthroplasty: 1-year follow-up of 2151 primary and 235 aseptic revision surgeries","volume":"46","author":"S B Winther","year":"2023","journal-title":"Orthopedics"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1302\/0301-620X.96B3.32525","article-title":"Five- to ten-year outcome following medial opening-wedge high tibial osteotomy with rigid plate fixation in combination with an artificial bone substitute","volume":"96-B","author":"T 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osteotomy for medial compartment knee osteoarthritis in patients aged \u226570 years versus younger patients","volume":"11","author":"M Nakashima","year":"2024","journal-title":"J Experiment Orthopaed"},{"issue":"07","key":"ref26","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1007\/s00264-024-06091-x","article-title":"Medium to long term of self-report outcomes of high tibial osteotomy in advanced age patients","volume":"48","author":"P Yuwen","year":"2024","journal-title":"Int Orthopaed"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1186\/s12877-025-06166-3","article-title":"High tibial osteotomy in geriatric patients with gonarthrosis","volume":"25","author":"B Akar","year":"2025","journal-title":"BMC Geriatr"},{"issue":"11","key":"ref28","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1302\/0301-620X.96B11.33617","article-title":"The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of 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cost-effectiveness of surgical treatment of medial unicompartmental knee osteoarthritis in younger patients: a computer model-based evaluation","volume":"97","author":"J F Konopka","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1007\/s00167-015-3821-3","article-title":"Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy","volume":"25","author":"W B Smith II","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"12","key":"ref43","doi-asserted-by":"crossref","first-page":"3563","DOI":"10.1016\/j.arth.2020.06.050","article-title":"Conversion total knee arthroplasty: prior fracture or osteotomy around the knee leads to increased resource utilization","volume":"35","author":"N B Frisch","year":"2020","journal-title":"J 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