{
  "abstract": "Purpose\n\nWe aimed to investigate long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy (OWHTO) according to Kellgren-Lawrence (KL) grade.Methods\n\nThis retrospective study included 274 knees (158 KL grade 4 [KL4] knees and 116 KL grades 2-3 [KL2-3] knees; mean age 64.7 ± 7.2 years) with a minimum follow-up of 10 years (mean follow-up, 12.5 ± 2.6 years) after OWHTO. Revision surgery (conversion to total knee arthroplasty [TKA] or unicompartmental knee arthroplasty [UKA]) was defined as the endpoint. Clinical and radiographic outcomes were evaluated. Multivariate logistic regression analyses were performed separately for KL4 and KL2-3 knees to identify factors associated with revision.Results\n\nThe mean Japanese Orthopaedic Association (JOA) score improved from 60.6 preoperatively to 91.0 at plate removal, followed by gradual deterioration during long-term follow-up. Final JOA scores were significantly lower in KL4 knees than in KL2-3 knees (71.6 versus 83.1; p < 0.001). Revision surgery was performed in 43 knees (15.7%) and was significantly more frequent in KL4 than in KL2-3 knees (22.2% versus 6.9%; p < 0.01). Ten-year joint preservation rates were 90.5% in KL4 knees and 96.5% in KL2-3 knees (log-rank p = 0.006). In KL4 knees, postoperative percentage mechanical axis (%MA) at the time of plate removal was independently associated with revision risk (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91-0.98; p = 0.004). In KL2-3 knees, an exploratory multivariate analysis suggested an association between progression of joint line convergence angle during follow-up (ΔJLCA) and revision (OR 3.31, 95% CI 1.52-7.21; p = 0.003), whereas postoperative %MA showed no significant association.Conclusions\n\nLong-term outcomes after OWHTO differed according to KL grade. KL4 knees demonstrated higher revision rates and inferior joint preservation survival, and postoperative weight-bearing line position was associated with revision risk. In contrast, revision was uncommon in KL2-3 knees, and exploratory analysis suggested a possible association with longitudinal changes in joint line convergence rather than postoperative alignment. These findings suggest that factors associated with revision may differ according to disease severity.Level of evidence\n\nThis was a level IV, retrospective cohort study.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Joint Surgery Center, Sakaide Kaisei Hospital, Sakaide, Japan. maseratthigransports@yahoo.co.jp.",
    "Department of Joint Surgery Center, Sakaide Kaisei Hospital, Sakaide, Japan.",
    "Department of Orthopaedic Surgery, Kagawa University, Miki, Japan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Noriyuki Gomi"
    },
    {
      "affs": [
        1
      ],
      "name": "Nobuhiro Chikaishi"
    },
    {
      "affs": [
        2
      ],
      "name": "Ryuichi Isozaki"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/32q1qhhhbph59.bib",
  "cited_by": 0,
  "doi": "10.1186/s43019-026-00351-3",
  "fulltext_url": "https://europepmc.org/articles/PMC13681812",
  "id": "32q1qhhhbph59",
  "issns": [
    "2234-0726",
    "2234-2451"
  ],
  "landing_url": "https://europepmc.org/article/MED/42902441",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RD701-811"
    ],
    [
      "openalex",
      "2746|Knee injuries and reconstruction techniques"
    ]
  ],
  "openalex": "W7223030997",
  "pdf_url": "https://europepmc.org/articles/PMC13681812?pdf=render",
  "pmcid": "PMC13681812",
  "pmid": "42902441",
  "published": "2026-10-20",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/32q1qhhhbph59.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:32Z",
      "native_id": "MED:42902441",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42902441"
    },
    {
      "first_seen": "2026-10-30T13:46:03Z",
      "native_id": "781c271145044d0eb086a6a07597ee25",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s43019-026-00351-3"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Knee injuries and reconstruction techniques",
      "subfield": "surgery"
    }
  ],
  "title": "Long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy in 274 knees: a Kellgren-Lawrence grade-stratified analysis.",
  "title_text": "Long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy in 274 knees: a Kellgren-Lawrence grade-stratified analysis.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:03Z",
  "url": "https://research.draconitic.com/paper/32q1qhhhbph59",
  "venue": "Knee surgery & related research",
  "versions": []
}