{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T22:39:04Z","timestamp":1792535944206,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee Surg &amp; Relat Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>We aimed to investigate long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy (OWHTO) according to Kellgren\u2013Lawrence (KL) grade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 274 knees (158 KL grade 4 [KL4] knees and 116 KL grades 2\u20133 [KL2\u20133] knees; mean age 64.7\u2009\u00b1\u20097.2\u00a0years) with a minimum follow-up of 10\u00a0years (mean follow-up, 12.5\u2009\u00b1\u20092.6\u00a0years) after OWHTO.<\/jats:p>\n                    <jats:p>Revision surgery (conversion to total knee arthroplasty [TKA] or unicompartmental knee arthroplasty [UKA]) was defined as the endpoint. Clinical and radiographic outcomes were evaluated. Multivariate logistic regression analyses were performed separately for KL4 and KL2\u20133 knees to identify factors associated with revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean Japanese Orthopaedic Association (JOA) score improved from 60.6 preoperatively to 91.0 at plate removal, followed by gradual deterioration during long-term follow-up. Final JOA scores were significantly lower in KL4 knees than in KL2\u20133 knees (71.6 versus 83.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Revision surgery was performed in 43 knees (15.7%) and was significantly more frequent in KL4 than in KL2\u20133 knees (22.2% versus 6.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Ten-year joint preservation rates were 90.5% in KL4 knees and 96.5% in KL2\u20133 knees (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). In KL4 knees, postoperative percentage mechanical axis (%MA) at the time of plate removal was independently associated with revision risk (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91\u20130.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). In KL2\u20133 knees, an exploratory multivariate analysis suggested an association between progression of joint line convergence angle during follow-up (\u0394JLCA) and revision (OR 3.31, 95% CI 1.52\u20137.21;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), whereas postoperative %MA showed no significant association.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term outcomes after OWHTO differed according to KL grade. KL4 knees demonstrated higher revision rates and inferior joint preservation survival, and postoperative weight-bearing line position was associated with revision risk. In contrast, revision was uncommon in KL2\u20133 knees, and exploratory analysis suggested a possible association with longitudinal changes in joint line convergence rather than postoperative alignment.<\/jats:p>\n                    <jats:p>These findings suggest that factors associated with revision may differ according to disease severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>This was a level IV, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43019-026-00351-3","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:47:56Z","timestamp":1792489676000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy in 274 knees: a Kellgren\u2013Lawrence grade-stratified analysis"],"prefix":"10.1186","volume":"38","author":[{"given":"Noriyuki","family":"Gomi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Chikaishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuichi","family":"Isozaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"3","key":"351_CR1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1007\/s00167-002-0334-7","volume":"11","author":"P Lobenhoffer","year":"2003","unstructured":"Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132\u2013138","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"7","key":"351_CR2","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1007\/s00167-013-2762-y","volume":"23","author":"G Bode","year":"2015","unstructured":"Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, S\u00fcdkamp N et al (2015) Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23(7):1949\u20131955","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"7","key":"351_CR3","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.3390\/jcm14072294","volume":"14","author":"Y Arai","year":"2025","unstructured":"Arai Y, Nakagawa S, Inoue A, Fujii Y, Cha R, Nakamura K et al (2025) Long-term outcomes and prognostic factors of medial open wedge high tibial osteotomy for medial compartment knee osteoarthritis or osteonecrosis. J Clin Med 14(7):2294","journal-title":"J Clin Med"},{"issue":"1","key":"351_CR4","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1177\/0363546510377445","volume":"39","author":"C Hui","year":"2011","unstructured":"Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM et al (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis. Am J Sports Med 39(1):64\u201370","journal-title":"Am J Sports Med"},{"issue":"11","key":"351_CR5","doi-asserted-by":"publisher","first-page":"3569","DOI":"10.1007\/s00167-020-06262-4","volume":"29","author":"B Ollivier","year":"2021","unstructured":"Ollivier B, Berger P, Depuydt C, Vandenneucker H (2021) Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sports Traumatol Arthrosc 29(11):3569\u20133584","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"1","key":"351_CR6","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1002\/ksa.70100","volume":"34","author":"A Mabrouk","year":"2026","unstructured":"Mabrouk A, Risebury M, Mumith A, Yasen S (2026) Medial opening wedge high tibial osteotomy yields comparable outcome across all Kellgren\u2013Lawrence osteoarthritis grades. Knee Surg Sports Traumatol Arthrosc 34(1):214\u2013228","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"351_CR7","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1136\/ard.16.4.494","volume":"16","author":"JH Kellgren","year":"1957","unstructured":"Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494\u2013502","journal-title":"Ann Rheum Dis"},{"issue":"Suppl 2","key":"351_CR8","doi-asserted-by":"publisher","first-page":"B55","DOI":"10.1016\/j.injury.2003.09.025","volume":"34","author":"AE Staubli","year":"2003","unstructured":"Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia\u2014early results in 92 cases. Injury 34(Suppl 2):B55-62","journal-title":"Injury"},{"key":"351_CR9","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1097\/00003086-198909000-00035","volume":"246","author":"A Miniaci","year":"1989","unstructured":"Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy: a new fixation device. Clin Orthop Relat Res 246:250\u2013259","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"351_CR10","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1302\/0301-620X.73B6.1955438","volume":"73","author":"K Ogata","year":"1991","unstructured":"Ogata K, Yoshii I, Kawamura H, Miura H, Arizono T, Sugioka Y (1991) Standing radiographs cannot determine the correction in high tibial osteotomy. J Bone Joint Surg Br 73(6):927\u2013931","journal-title":"J Bone Joint Surg Br"},{"issue":"6","key":"351_CR11","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1007\/s00776-012-0274-0","volume":"17","author":"M Okuda","year":"2012","unstructured":"Okuda M, Omokawa S, Okahashi K, Akahane M, Tanaka Y (2012) Validity and reliability of the Japanese Orthopaedic Association knee score. J Orthop Sci 17(6):750\u2013756","journal-title":"J Orthop Sci"},{"issue":"12","key":"351_CR12","doi-asserted-by":"publisher","first-page":"4344","DOI":"10.1002\/ksa.70071","volume":"33","author":"MD Ahrend","year":"2025","unstructured":"Ahrend MD, Petzold D, Histing T, Ihle C, Schr\u00f6ter S, Herbst M (2025) High survival rates and patient satisfaction 12 years after medial open wedge high tibial osteotomy surgery: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc 33(12):4344\u20134352","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"5","key":"351_CR13","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1002\/ksa.12633","volume":"33","author":"CA Brito Ayet","year":"2025","unstructured":"Brito Ayet CA, Mancino F, Lim YP, Qian K, Jacob G, Parker DA (2025) Satisfactory 10-year survivorship of medial opening wedge high tibial osteotomy for isolated medial compartment osteoarthritis and varus alignment. Knee Surg Sports Traumatol Arthrosc 33(5):1804\u20131814","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"9","key":"351_CR14","doi-asserted-by":"publisher","first-page":"3350","DOI":"10.1002\/ksa.12793","volume":"33","author":"A Maione","year":"2025","unstructured":"Maione A, Calanna F, Napolitano A, Parmigiani MD, Fedele G, Menon A et al (2025) High tibial osteotomy yields sufficient clinical and radiological results regardless of the site of deformity. Knee Surg Sports Traumatol Arthrosc 33(9):3350\u20133360","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"351_CR15","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/1471-2474-10-88","volume":"10","author":"TM van Raaij","year":"2009","unstructured":"van Raaij TM, Reijman M, Furlan AD, Verhaar JAN (2009) Total knee arthroplasty after high tibial osteotomy. A systematic review. BMC Musculoskelet Disord 10:88","journal-title":"BMC Musculoskelet Disord"},{"issue":"10","key":"351_CR16","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1007\/s43465-024-01250-z","volume":"58","author":"N Gomi","year":"2024","unstructured":"Gomi N, Muramoto H, Kataoka Y (2024) Occurrence of patellofemoral joint osteoarthritis in long-term postoperative cases of open-wedge high tibial osteotomy: differences in symptoms based on patient-standing type evaluation with and without patellofemoral joint osteoarthritis. Indian J Orthop 58(10):1411\u20131417","journal-title":"Indian J Orthop"}],"container-title":["Knee Surgery &amp; Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43019-026-00351-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43019-026-00351-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43019-026-00351-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T22:02:21Z","timestamp":1792533741000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43019-026-00351-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["351"],"URL":"https:\/\/doi.org\/10.1186\/s43019-026-00351-3","relation":{},"ISSN":["2234-2451"],"issn-type":[{"value":"2234-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"21 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Ethics Review Committee of Sakaide Kaisei Hospital (approval no. 2025-5) and was conducted in accordance with the principles of the Declaration of Helsinki. The requirement for informed consent was waived by the Ethics Review Committee because of the retrospective nature of the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"50"}}