Long‐term survivorship after medial open‐wedge high tibial osteotomy: A systematic review and single‐arm meta‐analysis with regional subgroup analysis

PURPOSE: To evaluate the long-term outcomes of medial open-wedge high tibial osteotomy (MOWHTO), focusing on conversion to knee arthroplasty and to summarize prognostic factors for conversion reported in the literature. METHODS: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched up to March 2025. Eligible studies reporting ≥10-year survival rates of MOWHTO-defined as the avoidance of conversion to knee arthroplasty-were included. Data were synthesized using a random-effects model. Subgroup analyses were performed based on region. RESULTS: A total of 16 studies encompassing 1906 knees were included in the final analysis. The pooled long-term non-conversion proportions following MOWHTO, defined as avoidance of knee arthroplasty, was 86% (95% confidence interval [CI]: 80%-90%). Numerically higher long-term non-conversion proportions were observed in Asian studies (92%) compared with European studies (84%). Narrative synthesis indicated durable long-term functional outcomes, with most patients avoiding arthroplasty for at least a decade. CONCLUSIONS: MOWHTO provides durable long-term outcomes, with an overall long-term non-conversion proportion of 86%. These findings could facilitate more personalized treatment strategies for different populations worldwide and ultimately reduce the socioeconomic burden associated with knee arthroplasty. LEVEL OF EVIDENCE: Level IV, systematic review and meta-analysis of Levels III-IV studies.