Comparison of clinical outcomes between high tibial osteotomy and total knee arthroplasty in early elderly patients with severe osteoarthritis

This study aimed to compare the clinical outcomes of high tibial osteotomy (HTO) and total knee arthroplasty (TKA) in early elderly patients with severe knee osteoarthritis (OA). This retrospective study included patients aged 65–74 years with Kellgren–Lawrence grade 4 medial knee OA who underwent either HTO or TKA. All patients had a minimum post-operative follow-up of 2 years. Propensity score matching was performed to balance baseline characteristics between the groups. Clinical outcomes were evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS), along with the achievement rates of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) for each KOOS subscale at final follow-up. Statistical comparisons were made using the unpaired t -test, paired t -test, and Fisher's exact test, with statistical significance set at p ​< ​0.05. A total of 27 matched pairs were analyzed. Pre-operatively, there were no statistically significant differences in KOOS subscale scores between the groups. At the final follow-up, KOOS symptoms and pain scores, as well as the MCID achievement rate for KOOS symptoms, were statistically significantly better in the TKA group than in the HTO group. PASS achievement rates did not differ statistically significantly between the groups. At a mean follow-up of 60.8 months, TKA resulted in better KOOS symptoms and pain scores and higher MCID achievement rate for KOOS symptoms than HTO. These findings suggest that TKA may offer more favorable outcomes than HTO for early elderly patients with severe medial knee OA. • Clinical outcomes of high tibial osteotomy and total knee arthroplasty (TKA) were compared. • Early elderly patients with severe osteoarthritis were included. • Knee injury and Osteoarthritis Outcome Score subscales for symptoms and pain were better in TKA. • TKA may offer more favorable symptom relief in this patient population.