Survivorship of the high tibial valgus osteotomy - A 10-to 22-year followup study

The results of 106 high tibial valgus osteotomies in 85 patients were evalu ated after a minimum 10-year followup to determine survivorship, complicati ons, and risk factors associated with failure. Using Kaplan-Meier survivors hip analysis, 73% of patients at 5 years, 51% of patients patients at 10 ye ars, 39% at 15 years, and 30% at 20 years after high tibial osteotomy had n ot required conversion of the high tibial osteotomy to a total knee arthrop lasty, Univariate Cox regression analysis of risk factors showed that age o lder than 50 years, previous arthroscopic debridement, presence of a latera l tibial thrust, preoperative knee flexion less than 120 degrees, insuffici ent valgus correction, and development of delayed union or nonunion were si gnificantly associated, with probability of early failure. Multivariate Cox regression analysis showed that a body mass index of less than 25 kg/m(2), presence of a lateral tibial thrust, and development of delayed union or n onunion were significantly associated with probability of early failure. Us ing recursive partitioning analysis of risk factors with the Wilcoxon test, a subset of patients who mere younger than 50 years of age and who had pre operative knee flexion greater than 120 degrees had a probability of surviv al after high tibial osteotomy approaching 95% at 5 years, 80% at 10 years, and 60% at 15 years. These results suggest that survival of high tibial os teotomy can be improved through careful patient selection and surgical tech nique.