Insall's 1984 retrospective study of 95 knees (83 patients) asks whether early promising HTO results hold up over time. Operations were performed from 1965-1976 with mean follow-up of 8.9 years. The study also evaluates optimal postoperative alignment and which patients are better served by TKA.
When a 52-year-old laborer with medial compartment OA and 8° varus asks about HTO, this is the paper you draw on.
Insall showed that HTO is best understood as a bridge procedure. Tell younger active patients it will likely give them 5-10 good years, not permanent relief. For patients over 60 or with varus exceeding 10°, the data clearly favor TKA from the start — 52% good/excellent vs 74% in the better-candidate group.
Postoperative alignment still matters technically: target 10° femorotibial valgus, accept 5-14°. But do not anchor your patient counseling on alignment precision. The underlying arthritis progresses regardless, and that progression, not alignment drift, is what drives failure.
One technical pearl for when these patients come back for TKA: bone quality in the proximal tibia is preserved after HTO, but the patellar tendon is shortened and the tibial shaft may lie eccentrically. Plan your exposure accordingly.
Insall's 1984 retrospective study of 95 knees (83 patients) asks whether early promising HTO results hold up over time. Operations were performed from 1965-1976 with mean follow-up of 8.9 years. The study also evaluates optimal postoperative alignment and which patients are better served by TKA.
When a 52-year-old laborer with medial compartment OA and 8° varus asks about HTO, this is the paper you draw on.
Insall showed that HTO is best understood as a bridge procedure. Tell younger active patients it will likely give them 5-10 good years, not permanent relief. For patients over 60 or with varus exceeding 10°, the data clearly favor TKA from the start — 52% good/excellent vs 74% in the better-candidate group.
Postoperative alignment still matters technically: target 10° femorotibial valgus, accept 5-14°. But do not anchor your patient counseling on alignment precision. The underlying arthritis progresses regardless, and that progression, not alignment drift, is what drives failure.
One technical pearl for when these patients come back for TKA: bone quality in the proximal tibia is preserved after HTO, but the patellar tendon is shortened and the tibial shaft may lie eccentrically. Plan your exposure accordingly.