Journal of the American Academy of Orthopaedic Surgeons · IF 2.9 · July 31, 2026 · LoE III
Risk and Timing of Total Knee Arthroplasty After High Tibial Osteotomy: A Cohort Study With 10-Year Follow-Up
Zachary D. Randall, Mitchell S. Mologne, Daniel E. Pereira, Robert H. Brophy — RAND Corporation
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).
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersHelps orthopedic 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.
Conclusion strengthConfirms prior evidence
No concurrent comparison group, so no between-group effect can be judged against the MCID.
Presenting this at rounds? Start here
- ?Should BMI optimization be a formal prerequisite before offering HTO, given the observed association between higher BMI and TKA conversion?
- ?How should surgeons counsel younger versus older patients differently about the expected timeline to eventual TKA after HTO?