Alignment after high tibial osteotomy: the role of arthritis severity
Archives of Orthopaedic and Trauma Surgery · 21 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Choosing the target alignment is the central planning decision in HTO, and this study offers early clinical data on the ESSKA consensus idea that the target should vary with arthritis severity.
The evidence
This single-centre retrospective study of 181 knees treated with open- or closed-wedge high tibial osteotomy (HTO) asked whether the postoperative weight-bearing line (under-, optimal or overcorrection) affects patient-reported improvement, and whether that depends on arthritis severity. In early osteoarthritis (Kellgren-Lawrence 2 or less), alignment category was significantly associated with Forgotten Joint Score-12 improvement (regression coefficient for the under versus over contrast -14.0 points, 95% CI -23.6 to -4.46); group means showed the smallest gains with overcorrection. In advanced osteoarthritis, no alignment-related associations were detected.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Retrospective cohortDesign starting point: 29.6
Raised the score
- Compared against current standard of care+3.4
Lowered the score
- A single centre's own patients−3.4
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upNot reported
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 29.6
- Compared against current standard of care
- +3.4
- A single centre's own patients
- −3.4
- Journal prior (not an observed method)
- +1.4
- Final rigour score rounded
- 31 / 100
Study design sets the starting point and a ceiling of 72. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.For a patient with early medial compartment OA and varus malalignment, how would you set and counsel about the target weight-bearing line, and how hard should you work to avoid landing above 70%?
2.If alignment seems to matter less in advanced OA, how should that change your choice between HTO, double-level osteotomy, and arthroplasty, and what would you tell these patients about expected function?
Original publication title
Postoperative alignment and patients reported outcome measures improvement after high tibial osteotomy: a significant interaction with osteoarthritis severity