{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:16:25Z","timestamp":1788315385258,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Knee osteoarthritis with medial\u2010compartment varus deformity is common in middle\u2010aged adults, and the optimal surgical strategy for this group remains debated, with open\u2010wedge high tibial osteotomy (OWHTO) and total knee arthroplasty (TKA) representing joint\u2010preserving and joint\u2010replacing options whose comparative long\u2010term value is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the cost\u2010effectiveness and long\u2010term outcomes of open\u2010wedge high tibial osteotomy (OWHTO) versus total knee arthroplasty (TKA) in middle\u2010aged patients with varus knee osteoarthritis:<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study analyzed registry data from three Chinese university affiliated hospitals. A total of 825 patients aged 45\u201365 who underwent OWHTO or TKA between 2005 and 2015 were included, with follow\u2010up through 2025. Outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, EQ\u20105D\u20105L utilities, range of motion (ROM), mechanical axis deviation (MAD), muscle strength, and total healthcare costs. Costs were assessed from a societal perspective (direct medical, direct non\u2010medical, and indirect productivity costs), and both costs and health outcomes were discounted at 3% annually. The EQ\u20105D\u20105L\u2013based quality\u2010adjusted life year (QALY) was the primary outcome; clinical and functional measures were secondary. Multivariate regression models were used to compare outcomes between groups, and 1000\u2010bootstrap simulations were used to estimate incremental cost\u2010effectiveness ratios (ICERs). ICERs were interpreted against a willingness\u2010to\u2010pay threshold of one to three times China's 2024 gross domestic product per capita (CNY 95,749\u2013287,247 per QALY). Robustness was assessed with inverse\u2010probability\u2010of\u2010treatment\u2010weighting (IPTW) and age\u2010stratified (45\u201354 vs. 55\u201365\u2009years) sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Clinical outcomes at final follow\u2010up did not differ significantly between OWHTO and TKA groups. OWHTO was associated with a lower cumulative cost (mean CNY 121,784) than TKA (CNY 160,075;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In cost\u2010effectiveness analyses, OWHTO was associated with better outcomes in WOMAC pain, mechanical alignment (MAD), ROM, and dynamic strength at a lower cost than TKA. Quality\u2010adjusted life year outcomes (EQ\u20105D\u20105L utility) slightly favored TKA (71.9% of bootstrap samples), yielding an ICER of CNY 5,441,410.25 per QALY for TKA relative to OWHTO, approximately 19 times the upper willingness\u2010to\u2010pay threshold (3\u00d7 GDP per capita, CNY 287,247 per QALY), indicating that the marginal utility gain with TKA was not cost\u2010effective. The reoperation\/revision rate did not differ between groups (OWHTO 0.95% [3\/316] vs. TKA 0.59% [3\/509];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.687), and findings were consistent in IPTW\u2010weighted and age\u2010stratified sensitivity analyses. Other ICERs were 146,719.91 CNY (WOMAC function), 53,934.07 CNY (WOMAC stiffness), 115,812.43 CNY (isometric strength), and 167,518.20 CNY (sit\u2010to\u2010stand power). Results were robust to sensitivity analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over more than 10\u2009years of follow\u2010up, OWHTO provided outcomes equivalent to TKA while substantially reducing costs. These findings support OWHTO as a cost\u2010effective option for selected middle\u2010aged patients with varus knee osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70390","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T10:25:07Z","timestamp":1784975107000},"page":"1958-1971","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness Analysis of Surgical Treatment of Varus Knee Osteoarthritis for Middle\u2010Aged Patients: A Multicenter Retrospective Cohort Study With Over 10\u2010Year Follow\u2010Up"],"prefix":"10.1111","volume":"18","author":[{"given":"Runhua","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Orthopedics Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjie","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixin","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0519-1593","authenticated-orcid":false,"given":"Manrong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9850-122X","authenticated-orcid":false,"given":"Yun","family":"Shen","sequence":"additional","affiliation":[{"name":"Pennington Biomedical Research Center  Baton Rouge Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5733-0754","authenticated-orcid":false,"given":"Da","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Xiangya Hospital, Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Rong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Minhang Hospital, Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5313-2902","authenticated-orcid":false,"given":"Shengdi","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"Pennington Biomedical Research Center  Baton Rouge Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1696929"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-0160(13)70004-8"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000127115.05754.ce"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2206-0"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.200934"},{"issue":"10","key":"e_1_2_12_7_1","first-page":"807","article-title":"Cost Effectiveness of Surgical Treatment of Medial Unicompartmental Knee Osteoarthritis in Younger Patients: A Computer Model\u2010Based Evaluation","volume":"97","author":"Konopka J. 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