What the Latest Research Means for Patients Considering Knee Replacement After High Tibial Osteotomy

This research by SORI surgeons Dr Myles Coolican and former Fellow Dr Ignacio Fernández was published in the Journal of ISAKOS in October 2025. Read HERE.

Knee osteoarthritis can lead to pain, stiffness, and a decline in daily function. For younger patients with misaligned knees, a high tibial osteotomy (HTO) offers a joint-preserving option to relieve pressure on the affected compartment and delay the need for a total knee replacement. However, arthritis can progress over time, and some patients eventually require a total knee arthroplasty (TKA) on the same knee.

Recent research by SORI surgeons Dr Myles Coolican and former Fellow Dr Ignacio Fernandez, published in the Journal of ISAKOS in October 2025, compared outcomes in patients who underwent TKA after a previous medial opening wedge HTO with those who had a primary TKA. The study showed that both groups experienced statistically significant improvements in knee function and overall physical health following surgery, with no difference between both groups post operatively. Measures such as the Oxford Knee Score (OKS) and the Veterans RAND 12-Item Health Survey (VR-12) showed similar improvements, indicating that conversion from HTO to TKA can be just as effective as a standard knee replacement.

For patients, these results are reassuring. Even if you have had an HTO, you can expect meaningful pain relief, improved mobility, and better quality of life when the time comes for  a knee replacement. The study also found that range of motion improved in both groups, with only minor differences, with no statiscally difference, suggesting that patients can regain functional movement comparable to someone undergoing a primary TKA.

The research did note that patella baja - a lower positioning of the kneecap - was slightly more frequent in patients converting from HTO, but again, this difference did not reach statistical significance. Hospital stays tended to be longer in this group, wich was the only otucome where a significant difference was detected, but it did not meaningfully affect overall results  This study highlights the importance of careful preoperative planning and discussion with the  surgical team prior to replacement.

In practical terms, patients considering TKA after HTO should feel confident that a prior osteotomy does not limit the potential benefits of knee replacement. Surgeons can tailor the procedure to account for previous surgery, preserving function and optimising outcomes.

Ultimately, this study emphasizes that conversion from HTO to TKA is a reliable and  effective solution for patients whose arthritis has progressed. For anyone facing this pathway, it means that long-term pain relief and improved knee function remain achievable, even after previous joint-preserving surgery. With careful planning and rehabilitation, patients can look forward to regaining mobility, returning to daily activities, and enjoying a better quality of life.