{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:32:28Z","timestamp":1792603948908,"version":"4.5.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Essential Surgical Techniques"],"published-print":{"date-parts":[[2015,11,25]]},"abstract":"<jats:p>Valgus-producing high tibial osteotomy (HTO) is a well-accepted treatment modality in active patients with varus malalignment and symptomatic medial unicompartmental osteoarthritis (OA) of the knee. One of the key factors for long-term success of the osteotomy is the achievement of an even distribution of the mechanical load on the knee joint by obtaining an ideal alignment of the lower-extremity mechanical axis. Proper surgical techniques are very important, and lateral closing wedge proximal tibial valgus osteotomy (CWO) is highly effective in achieving the desired overcorrection of 3\u00b0 to 7\u00b0 of valgus.<\/jats:p>\n                  <jats:p>The major steps of CWO are (1) preoperative planning, in which the frontal plane varus knee deformity is assessed on a standard whole-leg radiograph; (2) a transverse anterolateral incision from the tubercle toward the posterior aspect of the proximal part of the fibular head; (3) exposure and snaring of the common peroneal nerve; (4) resection of the anterior aspect of the proximal part of the fibular head; (5) use of a calibrated slotted wedge resection guide to perform the osteotomy proximal to the tuberosity under fluoroscopic guidance; (6) removal of an osseous wedge and closure of the osteotomy site, with the medial opposite cortex acting as a hinge; and (7) fixation of the osteotomy site with two step staples. Complications (e.g., nonunion, deep infection, and peroneal neuropathy) are rare. At follow-up, CWO has been shown to improve knee function and reduce pain. Male patients with early-onset knee OA have an almost ten times lower probability of failure of a CWO than women with more degenerative disease. The survival rate, with knee replacement as the end point, is approximately 75% at ten years following CWO. CWO postpones primary total knee arthroplasty (TKA) for a median of seven years, and there is low-quality evidence that osteotomy does not compromise subsequent knee replacement.<\/jats:p>","DOI":"10.2106\/jbjs.st.n.00104","type":"journal-article","created":{"date-parts":[[2015,11,25]],"date-time":"2015-11-25T22:50:06Z","timestamp":1448491806000},"page":"e26","source":"Crossref","is-referenced-by-count":19,"title":["Proximal Tibial Valgus Osteotomy: Lateral Closing Wedge"],"prefix":"10.2106","volume":"5","author":[{"given":"Tom M.","family":"van Raaij","sequence":"first","affiliation":[{"name":"Martini Hospital Groningen, Van Swietenplein 1, P.O. Box 30033, Postal Code 9700 RM, Groningen, the Netherlands. E-mail address for T.M. van Raaij:"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinoud W.","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Martini Hospital Groningen, Van Swietenplein 1, P.O. Box 30033, Postal Code 9700 RM, Groningen, the Netherlands. E-mail address for T.M. van Raaij:"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230812","article-title":"Osteotomy for treating knee osteoarthritis [review]","volume":"12","author":"Brouwer","year":"2014","journal-title":"Cochrane Database Syst Rev."},{"issue":"2","key":"bib2-20230812","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1080\/17453670710015021","article-title":"Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10-16 years","volume":"79","author":"van Raaij","year":"2008","journal-title":"Acta Orthop."},{"issue":"4","key":"bib3-20230812","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1080\/17453670710015508","article-title":"Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique","volume":"79","author":"van Raaij","year":"2008","journal-title":"Acta Orthop."},{"key":"bib4-20230812","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/1471-2474-15-124","article-title":"High tibial osteotomy: closed wedge versus combined wedge osteotomy","volume":"15","author":"Huizinga","year":"2014","journal-title":"BMC Musculoskelet Disord."},{"issue":"17","key":"bib5-20230812","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.2106\/JBJS.M.00786","article-title":"Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up","volume":"96","author":"Duivenvoorden","year":"2014","journal-title":"J Bone Joint Surg Am."},{"key":"bib6-20230812","article-title":"Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment","author":"van Egmond","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"3","key":"bib8-20230812","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.rdc.2008.05.007","article-title":"Epidemiology of osteoarthritis","volume":"34","author":"Zhang","year":"2008","journal-title":"Rheum Dis Clin North Am."},{"issue":"3","key":"bib9-20230812","doi-asserted-by":"crossref","first-page":"244","DOI":"10.3109\/17453674.2012.688725","article-title":"High tibial osteotomy in Sweden, 1998-2007: a population-based study of the use and rate of revision to knee arthroplasty","volume":"83","author":"W-Dahl","year":"2012","journal-title":"Acta Orthop."},{"issue":"5","key":"bib10-20230812","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1080\/000164701753532853","article-title":"The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997","volume":"72","author":"Robertsson","year":"2001","journal-title":"Acta Orthop Scand."},{"issue":"2","key":"bib11-20230812","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.knee.2008.10.003","article-title":"Conventional knee films hamper accurate knee alignment determination in patients with varus osteoarthritis of the knee","volume":"16","author":"van Raaij","year":"2009","journal-title":"Knee."},{"issue":"4","key":"bib12-20230812","doi-asserted-by":"crossref","first-page":"689","DOI":"10.3109\/17453678008990862","article-title":"Optimal correction in high tibial osteotomy for varus deformity","volume":"51","author":"Myrnerts","year":"1980","journal-title":"Acta Orthop Scand."}],"container-title":["JBJS Essential Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01709766-201505040-00008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:29:20Z","timestamp":1787750960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01709766-201505040-00008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,25]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2015]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.st.n.00104","relation":{},"ISSN":["2160-2204"],"issn-type":[{"value":"2160-2204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,25]]}}}