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ArthroplastyCohort

Risk and Timing of Total Knee Arthroplasty After High Tibial Osteotomy: A Cohort Study With 10-Year Follow-Up

Journal of the American Academy of Orthopaedic Surgeons · 31 Jul 2026

Rigour42/100
Clinical42/100
Impact†—/100

† 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

Helps orthopaedic surgeons counsel patients considering joint-preserving HTO about realistic long-term odds of eventually needing TKA, particularly regarding age and BMI as modifiable/nonmodifiable risk factors.

The evidence

This retrospective cohort study followed 207 patients who underwent high tibial osteotomy (HTO) for medial compartment knee osteoarthritis, using a synthetic deidentified data platform, for a mean of 17.8 years. About 10% (20/207) eventually converted to total knee arthroplasty (TKA), with conversion rising from 5.9% at 10 years to 22.0% at 20 years; patients who converted were older and had higher BMI at the time of HTO, and higher BMI independently predicted TKA conversion (RR 1.13, 95% CI 1.04-1.23, p=0.004).

conversion to TKA: Risk ratio 1.13 (95% CI 1.04 to 1.23; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.

Why this rigour score?

Retrospective cohort

42/ 100

Methods at a glance

Recorded assessment
  • Confounding adjustmentMultivariable regression
  • Covariate balance confirmedNot applicable
  • Outcome assessors blindedNot applicable
  • Comparable start of follow-upMet
  • 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.

How to read this assessment

The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.

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.Should BMI optimisation be a formal prerequisite before offering HTO, given the observed association between higher BMI and TKA conversion?

2.How should surgeons counsel younger versus older patients differently about the expected timeline to eventual TKA after HTO?

Original publication title

Risk and Timing of Total Knee Arthroplasty After High Tibial Osteotomy: A Cohort Study With 10-Year Follow-Up

Read original paper